Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S179-84; discussion S185-S190. doi: 10.1016/j.jtcvs.2010.06.031. Epub 2010 Jul 21.
This study evaluated long-term results of thoracic endovascular aortic repair for atherosclerotic aneurysms involving descending aorta.
One hundred thirteen patients underwent thoracic endovascular aortic repair for this indication from 1996 to 2009. Mean follow-up was 54 ± 38 months (5-144 months). In-hospital mortality, neurologic injury, need for rerouting, occurrence of endoleaks and their treatment, and survival were recorded.
In-hospital mortality was 5.3%. Transient neurologic injury rate was 2.6%. Previous rerouting was performed in 51%. Assisted early and late type I and III endoleak rates were 7.9% and 5.7%, respectively. Five percent of patients required late surgical conversion. Actuarial survivals were 86%, 60%, and 42% at 1, 5, and 10 years, respectively. Aorta-related actuarial survivals were 94%, 90%, and 83% at 1, 5, and 10 years, respectively. Cox regression analysis revealed higher number of prostheses as independent risk factor for early (hazard ratio, 5.38; 95% confidence interval, 1.68-42.37) and late (hazard ratio, 8.49; 95% confidence interval, 1.09-66.06) endoleak formation. Female sex (hazard ratio, 0.35; 95% confidence interval, 0.13-0.99), no arch involvement (hazard ratio, 0.21; 95% confidence interval, 0.05-0.08), and higher number of prostheses (hazard ratio, 7.95; 95% confidence interval, 1.36-46.58) affected survival.
Aorta-related survival is excellent among patients undergoing thoracic endovascular aortic repair for atherosclerotic aneurysms involving the descending aorta. Life-long surveillance remains mandatory, with early and late failure uncommon but still needing consideration. Thoracic endovascular aortic repair in this group of patients remains attractive and has now proven durability.
本研究评估了胸主动脉腔内修复术治疗累及降主动脉的粥样硬化性动脉瘤的长期结果。
1996 年至 2009 年，113 例患者因该指征接受了胸主动脉腔内修复术。平均随访时间为 54±38 个月（5-144 个月）。记录院内死亡率、神经损伤、需要重新布线、内漏的发生及其治疗以及生存率。
院内死亡率为 5.3%。暂时性神经损伤发生率为 2.6%。51%的患者之前进行过再布线。辅助早期和晚期 1 型和 3 型内漏的发生率分别为 7.9%和 5.7%。5%的患者需要晚期手术转换。1、5 和 10 年的累积生存率分别为 86%、60%和 42%。主动脉相关的累积生存率分别为 94%、90%和 83%，1、5 和 10 年。Cox 回归分析显示，支架数量较多是早期（危险比，5.38；95%置信区间，1.68-42.37）和晚期（危险比，8.49；95%置信区间，1.09-66.06）内漏形成的独立危险因素。女性（危险比，0.35；95%置信区间，0.13-0.99）、无弓部受累（危险比，0.21；95%置信区间，0.05-0.08）和支架数量较多（危险比，7.95；95%置信区间，1.36-46.58）均影响生存率。
接受胸主动脉腔内修复术治疗累及降主动脉的粥样硬化性动脉瘤的患者，主动脉相关生存率非常高。仍需进行终身监测，早期和晚期失败并不常见，但仍需考虑。在这组患者中，胸主动脉腔内修复术仍然具有吸引力，且现在已证明其具有持久性。
