Vaghetti Marco, Palmieri Cataldo, Al-Jabri Anees, Ravani Marcello, Rizza Antonio, Trianni Giuseppe, Mariani Massimiliano, Glauber Mattia, Troiani Roberto, Chiappino Dante, Berti Sergio
Department of Cardiology, Pasquinucci Heart Hospital, Gabriele Monasterio Foundation, Via Aurelia Sud 54100, Massa, Italy.
J Invasive Cardiol. 2011 May;23(5):187-92.
To report the procedural and long-term follow-up data (mean, 43 ± 29 months; range, 12-90 months) of endovascular stent grafting (ESG) of acute thoracic aortic syndromes (ATAS) with a proximal landing zone extension strategy.
From November 1999 to May 2008, 26 patients (25 males, 1 female; mean age, 57.9 ± 17 years) with ATAS underwent ESG at our institution. Underlying pathologies were: penetrating aortic ulcer (n=7); rupture of a descending aorta aneurysm (n=5), post-traumatic false aneurysm (n=5); acute type B dissection (n=6) and traumatic descending aorta transection (n=3).
ESG was performed successfully in all patients. In 5 patients (19%), an extra-anatomic revascularization of the supra-aortic vessels was performed. In 19 patients (73%), overstenting of the left subclavian artery, without preliminary revascularization, was performed. The mean proximal landing zone length was 57 ± 19 mm. No intraprocedural deaths occurred; 3 patients died postoperatively (1 from an unrelated cause, 1 from a myocardial infarction and 1 for the sequelae of an ischemic stroke). One patient underwent cardiac surgery for post-procedural retrograde type-A dissection. Follow up involved a computed tomography (CT) scan at 1, 3, 6 and 12 months, then yearly thereafter. At follow up, no deaths or major complications occurred. The CT scans revealed 1 small type-IB endoleak at 1 year.
In ATAS patients treated with ESG, the extension of the proximal landing zone, despite the need of subclavian coverage or hybrid procedures, is associated with an immediate procedural outcome and low morbidity at follow-up.
报告采用近端锚定区扩展策略对急性胸主动脉综合征（ATAS）进行血管内支架植入术（ESG）的手术过程及长期随访数据（平均43±29个月；范围12 - 90个月）。
1999年11月至2008年5月，26例ATAS患者（25例男性，1例女性；平均年龄57.9±17岁）在我院接受ESG治疗。潜在病因包括：穿透性主动脉溃疡（n = 7）；降主动脉瘤破裂（n = 5），创伤后假性动脉瘤（n = 5）；急性B型主动脉夹层（n = 6）和创伤性降主动脉横断（n = 3）。
所有患者ESG手术均成功。5例患者（19%）进行了主动脉弓上血管的解剖外血管重建。19例患者（73%）在未预先进行血管重建的情况下对左锁骨下动脉进行了重叠支架植入。近端锚定区平均长度为57±19 mm。术中无死亡发生；3例患者术后死亡（1例死于无关原因，1例死于心肌梗死，1例死于缺血性中风后遗症）。1例患者因术后逆行A型夹层而接受心脏手术。随访包括在1、3、6和12个月时进行计算机断层扫描（CT），此后每年进行一次。随访期间，无死亡或重大并发症发生。CT扫描显示1年后有1例小型ⅠB型内漏。
在接受ESG治疗的ATAS患者中，尽管需要覆盖锁骨下动脉或采用杂交手术，但近端锚定区的扩展与即时手术效果及随访时的低发病率相关。
