Director of Endovascular Program, Christine E. Lynn Heart and Vascular Institute, 670 Glades Road, Boca Raton, FL 33431, USA.
Circulation. 2011 Jun 28;123(25):2938-45. doi: 10.1161/CIRCULATIONAHA.110.965756. Epub 2011 Jun 6.
In this study, we report the late outcomes of a large, decade-long single-center thoracic endovascular aortic repair experience.
A prospectively maintained registry and the electronic medical records of 400 consecutive thoracic endovascular aortic repair performed at a tertiary care center were reviewed. The distribution of pathologies treated included aneurysms (198, 49%), dissections (100, 25%), penetrating ulcers (54, 14%), traumatic transections (25, 6%), and other pathologies (23, 6%). Spinal drains were placed prophylactically in 127 cases (32%) of planned extended aortic coverage. There were no acute surgical conversions. Adjunctive surgical procedures were performed on 94 patients (24%). Subclavian revascularizations were performed selectively in only 15% of zone 0 to 2 deployments. The median length of stay was 5 days (limits, 1 and 79 days). Overall 30-day mortality was 6.5% (elective, 2.6%; urgent, 9.5%; and emergent, 20%). Permanent spinal cord ischemia occurred in 4.5% and stroke in 3%. Kaplan-Meier estimates of survival were 82%, 76%, 68%, and 60% and freedom from secondary intervention was 90%, 86%, 81%, and 78% at 6, 12, 24, and 36 months, respectively. Risk factors for mortality included stroke, urgent/emergent repair, age ≥80 years, general anesthesia, and dissection pathology.
Thoracic endovascular aortic repair may be used to treat a variety of thoracic aortic pathologies with a very low risk of intraoperative conversion. Overall rates of mortality and neurological complications were relatively low but significantly increased in emergent repairs. There appeared to be a substantial number of late deaths, which may represent a combination of poor patient selection and treatment failures.
本研究报告了一项历时十余年、单中心的大型胸主动脉腔内修复术经验的长期结果。
我们回顾了在一家三级保健中心进行的 400 例连续胸主动脉腔内修复术的前瞻性维护登记和电子病历。治疗的病变分布包括动脉瘤（198 例，49%）、夹层（100 例，25%）、穿透性溃疡（54 例，14%）、创伤性横断（25 例，6%）和其他病变（23 例，6%）。计划行主动脉延长覆盖时预防性放置脊髓引流管 127 例（32%）。无急性手术转换。94 例（24%）患者行辅助手术。仅选择性对 0 区至 2 区的支架进行锁骨下动脉血运重建。中位住院时间为 5 天（范围 1 至 79 天）。总体 30 天死亡率为 6.5%（择期 2.6%；紧急 9.5%；急诊 20%）。永久性脊髓缺血发生率为 4.5%，卒中发生率为 3%。6、12、24 和 36 个月时，Kaplan-Meier 生存估计值分别为 82%、76%、68%和 60%，二次干预的无复发率分别为 90%、86%、81%和 78%。死亡的危险因素包括卒中、紧急/急诊修复、年龄≥80 岁、全身麻醉和夹层病变。
胸主动脉腔内修复术可用于治疗多种胸主动脉病变，术中转换风险极低。总的死亡率和神经并发症发生率相对较低，但在紧急修复中显著增加。似乎有相当数量的晚期死亡，这可能代表了患者选择和治疗失败的综合因素。
