Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
Ann Thorac Surg. 2011 Jan;91(1):85-91. doi: 10.1016/j.athoracsur.2010.08.053.
We analyzed the potential of endovascular stent grafts to treat late aortic pseudoaneurysms after coarctation repair.
Eight patients (7 male; age 28 to 58, mean 43 years) presented with aortic pseudoaneurysms after primary repair performed at the age of 5 to 27 (mean 12) years; 2 patients had rupture with hemorrhagic shock. The mean interval between the procedures was 31 (19 to 42) years; one patient had 3 previous operations. This subset represents 2.2% of our overall experience in thoracic endovascular repair (n=368). Thoracic endografts were implanted using the transfemoral technique. Custom-made reverse tapered stent grafts were used in 4 cases. The left subclavian artery (LSA) was covered in 5 patients. Protective transposition of the left subclavian artery was performed in 4 patients.
Hospital mortality was 12.5%; 1 patient died from secondary rupture after emergency repair. Primary complete exclusion of the aneurysm was achieved in 6 patients. Secondary exclusion after implantation of a second stent graft was successful in the second rupture patient. No endoleak was present at discharge. All discharged patients are alive after 8 to 63 (mean 36) months. Follow-up computed tomography or transesophageal echocardiography revealed no secondary endoleaks or late expansion. The pseudoaneurysms had shrunk completely in 3 patients, were reduced in size in 2 patients, and remained unchanged in 2 patients. No late secondary interventions were noted.
Single piece, reversed, tapered stent grafts adapt better to the special anatomy of the hypoplastic aortic arch. Midterm results are excellent; complete shrinkage in 50% is remarkable. However, the long-term behavior of these implants in young patients requires further evaluation and surveillance.
我们分析了血管内支架移植物治疗缩窄修复后晚期主动脉假性动脉瘤的潜力。
8 名患者（7 名男性；年龄 28 至 58 岁，平均 43 岁）在 5 至 27 岁（平均 12 岁）时接受初次修复后出现主动脉假性动脉瘤；2 例伴有破裂伴出血性休克。两次手术的平均间隔为 31（19 至 42）年；1 例患者有 3 次手术史。这组患者代表了我们 368 例胸主动脉腔内修复经验的 2.2%。经股动脉技术植入胸主动脉内移植物。4 例使用定制的反向锥形支架移植物。5 例患者覆盖左锁骨下动脉（LSA）。4 例患者行左锁骨下动脉保护性转位。
院内死亡率为 12.5%；1 例患者在紧急修复后死于二次破裂。6 例患者首次完全排除动脉瘤。在第二次破裂患者中，植入第二个支架移植物后，二次排除成功。出院时无内漏。所有出院患者在 8 至 63 个月（平均 36 个月）后均存活。随访计算机断层扫描或经食管超声心动图显示无继发性内漏或晚期扩张。3 例患者假性动脉瘤完全缩小，2 例患者假性动脉瘤缩小，2 例患者假性动脉瘤无变化。无晚期二次干预。
单一片段、反向、锥形支架移植物更适合发育不良主动脉弓的特殊解剖结构。中期结果极佳；50%的完全缩小是显著的。然而，这些植入物在年轻患者中的长期行为需要进一步评估和监测。
