Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Ann Thorac Surg. 2011 Apr;91(4):1141-6. doi: 10.1016/j.athoracsur.2010.12.033.
We evaluated mechanisms of failure and outcome of secondary surgical interventions after thoracic endovascular aortic repair (TEVAR).
Between 1996 and 2009, 421 patients underwent TEVAR for the following indications: atherosclerotic aneurysms, type B dissections, penetrating ulcers and traumatic lesions.
Twenty-one patients underwent secondary surgical interventions. Indications were type I endoleak formation, retrograde type A dissection, distal aneurysm formation as well as infection. Retrospectively, by analysing referral computed tomography scans and by current knowledge, failure could have been foreseen in 72% of patients. Median interval to secondary surgical intervention was 24 months (IQR 8-40). Sixteen patients underwent thoracic or thoracoabdominal repair and five patients underwent ascending and hemiarch replacement. In-hospital mortality was 19%. Cause of death was multiorgan failure in all cases.
The need for secondary surgical intervention after TEVAR is low but carries risk. By analysing mechanisms of failure, the majority of these events could have been avoided by a more strict indication. Thereby, further critical evaluation and respecting limitations of TEVAR will help to reduce the need for these operations.
我们评估了胸主动脉腔内修复术（TEVAR）后二次手术干预的失败机制和结果。
1996 年至 2009 年间，421 例患者因以下适应症接受了 TEVAR 治疗：动脉粥样硬化性动脉瘤、B 型夹层、穿透性溃疡和创伤性损伤。
21 例患者接受了二次手术干预。适应症为 I 型内漏形成、逆行性 A 型夹层、远端动脉瘤形成以及感染。通过回顾性分析转诊计算机断层扫描，并根据现有知识，72%的患者可以预见失败。二次手术干预的中位间隔时间为 24 个月（IQR 8-40）。16 例患者接受了胸或胸腹主动脉修复，5 例患者接受了升主动脉和半弓置换。住院死亡率为 19%。所有病例的死亡原因为多器官功能衰竭。
TEVAR 后需要二次手术干预的情况很少，但存在风险。通过分析失败的机制，通过更严格的适应证，可以避免大多数这些事件的发生。因此，进一步的严格评估和尊重 TEVAR 的局限性将有助于减少这些手术的需求。
