San Norberto García Enrique M, González-Fajardo José A, Gutiérrez Vicente, Fernández Beatriz, San Román Alberto, Vaquero Carlos
Division of Angiology and Vascular Surgery, Valladolid University Hospital, Valladolid, Spain.
Ann Vasc Surg. 2010 Nov;24(8):1068-74. doi: 10.1016/j.avsg.2010.04.006.
The aim of this study was to compare the results of endovascular therapy (covered stenting) with surgical technique to repair aortic coarctation in adults.
A prospective study of 11 patients who were treated during the past 10 years was carried out. Of these, five patients underwent endoprosthesis (group A) and six an open surgical repair (group B). Follow-up comprised monitoring of the blood pressure, echocardiography, and computed tomography and magnetic resonance angiographic studies.
The mean age of the patients was 46 years (range: 17-67 years) and the mean follow-up was 52.6 months (range: 1-117 months; 32.3 for group A vs. 69.7 for group B; p = 0.01). Two cases in group A were recoarctations after child angioplasty. The rate of postoperative complications was 27.7% (one hemothorax for group A vs. one pneumothorax and one hemothorax for group B); however, mortality did not occur. The success rate of the endovascular technique was 80%. The stay in the intensive care unit was 2.3 days with significant differences (one group A vs. three group B; p = 0.01), whereas length of hospital stay was 11 days (7.8 group A vs. 11.83 group B; p = 0.17). The pressure gradient across the stenosis decreased by 21.9 ± 3.7 mm Hg (24.5 ± 4.3 group A vs. 33 ± 3.2 group B). Six patients (54.5%) showed persistent hypertension (80% group A vs. 33% group B), with a mean residual pressure gradient of 23.4 ± 4.3 mm Hg (22.5 ± 5.4 group A vs. 22 ± 2.1 group B; p = 0.58).
Short- and medium-term results of the endovascular therapy are similar, with shorter stay in the intensive care unit and higher necessity of antihypertensive treatment. Echocardiography and Doppler aortic coarctation gradients slightly higher than 20 mm Hg are usual during follow-up.
本研究旨在比较成人主动脉缩窄血管内治疗（覆膜支架置入）与外科手术修复的结果。
对过去10年中接受治疗的11例患者进行了一项前瞻性研究。其中，5例患者接受了腔内修复术（A组），6例接受了开放手术修复（B组）。随访包括血压监测、超声心动图检查以及计算机断层扫描和磁共振血管造影研究。
患者的平均年龄为46岁（范围：17 - 67岁），平均随访时间为52.6个月（范围：1 - 117个月；A组为32.3个月，B组为69.7个月；p = 0.01）。A组中有2例是儿童血管成形术后再发缩窄。术后并发症发生率为27.7%（A组1例血胸，B组1例气胸和1例血胸）；然而，未发生死亡。血管内技术的成功率为80%。在重症监护病房的停留时间为2.3天，存在显著差异（A组1天，B组3天；p = 0.01），而住院时间为11天（A组7.8天，B组11.83天；p = 0.17）。狭窄部位的压力阶差降低了21.9 ± 3.7 mmHg（A组24.5 ± 4.3 mmHg，B组33 ± 3.2 mmHg）。6例患者（54.5%）表现为持续性高血压（A组80%，B组33%），平均残余压力阶差为23.4 ± 4.3 mmHg（A组22.5 ± 5.4 mmHg，B组22 ± 2.1 mmHg；p = 0.58）。
血管内治疗的短期和中期结果相似，在重症监护病房的停留时间较短，但抗高血压治疗的必要性更高。随访期间，超声心动图和多普勒测量的主动脉缩窄压力阶差通常略高于20 mmHg。
