Department of Vascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Surg Today. 2011 Jul;41(7):922-7. doi: 10.1007/s00595-010-4377-y. Epub 2011 Jul 12.
To minimize surgical invasiveness for extensive aortic aneurysms and expand the indications for thoracic endovascular aortic repair (TEVAR), we evaluated outcomes of hybrid procedures combining conventional surgical aortic repair and TEVAR for thoracic aortic aneurysms.
The following hybrid procedures were performed: second-stage TEVAR after total aortic arch replacement using the elephant trunk as the landing zone in 17 patients; and for multiple aortic aneurysms, vascular graft replacement and TEVAR in 13 patients, vascular graft replacement and TEVAR with bypass in 2 patients, and TEVAR with bypass in 23 patients.
There were three (5.3%) hospital deaths, from serious complications including stroke, paraplegia, paraparesis, and aspiration pneumonia; and eight late deaths. There was only one aneurysm-related death, of a patient who underwent emergency surgery for an esophageal fistula resulting from enlargement of a residual false lumen of a thoracoabdominal aorta after second-stage TEVAR.
Hybrid procedures minimize surgical invasiveness in thoracic aortic aneurysm repair, but further evaluation of a larger number of patients is necessary.
为了减少广泛主动脉瘤的手术侵袭性并扩大胸主动脉腔内修复术（TEVAR）的适应证，我们评估了将传统的主动脉外科修复术与 TEVAR 相结合的杂交手术治疗胸主动脉瘤的结果。
进行了以下杂交手术：17 例患者采用象鼻作为着陆区行全主动脉弓置换后的二期 TEVAR；对于多发性主动脉瘤，13 例患者行血管移植物置换和 TEVAR，2 例患者行血管移植物置换和旁路 TEVAR，23 例患者行旁路 TEVAR。
3 例（5.3%）患者在院死亡，均由严重并发症引起，包括卒中、截瘫、不全截瘫和吸入性肺炎；8 例患者死于晚期。只有 1 例与动脉瘤相关的死亡，是一位患者在二期 TEVAR 后因胸腹主动脉残余假腔扩大导致食管瘘而进行急诊手术。
杂交手术可减少胸主动脉瘤修复的手术侵袭性，但需要对更多患者进行进一步评估。
