Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre of Guy's and St. Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, United Kingdom.
J Vasc Surg. 2011 Dec;54(6):1580-7. doi: 10.1016/j.jvs.2011.07.034. Epub 2011 Sep 25.
The term acute aortic syndrome (AAS) encompasses a range of conditions that have a risk of imminent aortic rupture and where delays in treatment result in increased mortality. Endovascular treatment offers an attractive alternative to open surgery but little is known about the durability of the repair and the factors that predict mortality.
Prospective data were collected for a cohort of 110 consecutive patients with endovascular treatment for AAS. Patient and procedural characteristics were related to short- and midterm outcome using multivariate logistic regression analysis.
There were 75 men and 35 women with a median age of 68 (range 57-76) years. The pathologies treated were acute dissection (35), symptomatic aneurysm (32), infected aneurysm (18), transection (12), chronic dissection (9), penetrating ulcer (3), and intramural hematoma (1). Thirty-day mortality was 12.7% and this was associated with hypotension (odds ratio [OR], 5.25), use of general anesthetic (OR, 5.23), long procedure duration (OR, 2.03), and increasing age (OR, 1.07). The causes of death were aortic rupture (4), myocardial infarction (4), stroke (3), and multisystem organ failure (3). The stroke and paraplegia rates were 7.3% and 6.4%, respectively. The 1-year survival was 81% and the 5-year survival 63%. Secondary procedures were required in 13 (11.8%) patients. Factors associated with death at 1 year were presence of an aortic fistula (OR, 9.78), perioperative stroke (OR, 5.87), and use of general anesthetic (OR, 3.76); and at 5 years were aortic fistula (OR, 12.31) and increasing age (OR, 1.06).
Acute aortic syndrome carries significant early and late mortality. Emergency endovascular repair offers a minimally invasive treatment option associated with acceptable short and midterm results. Continued surveillance is important as secondary procedures and aortic-related deaths continue to occur throughout the follow-up period.
急性主动脉综合征（AAS）涵盖了一系列具有主动脉破裂风险的病症，治疗延误会增加死亡率。血管内治疗为开放手术提供了一种有吸引力的替代方法，但对于修复的耐久性以及预测死亡率的因素知之甚少。
对 110 例连续接受 AAS 血管内治疗的患者进行前瞻性数据收集。使用多变量逻辑回归分析，将患者和手术特点与短期和中期结果相关联。
患者中男性 75 例，女性 35 例，中位年龄 68 岁（范围 57-76 岁）。治疗的病变包括急性夹层（35 例）、有症状的动脉瘤（32 例）、感染性动脉瘤（18 例）、横断（12 例）、慢性夹层（9 例）、穿透性溃疡（3 例）和壁内血肿（1 例）。30 天死亡率为 12.7%，与低血压（优势比[OR]，5.25）、全身麻醉（OR，5.23）、手术时间长（OR，2.03）和年龄增长（OR，1.07）相关。死亡原因包括主动脉破裂（4 例）、心肌梗死（4 例）、中风（3 例）和多器官功能衰竭（3 例）。中风和截瘫的发生率分别为 7.3%和 6.4%。1 年生存率为 81%，5 年生存率为 63%。13 例（11.8%）患者需要进行二次手术。1 年死亡的相关因素包括存在主动脉瘘（OR，9.78）、围手术期中风（OR，5.87）和全身麻醉（OR，3.76）；5 年死亡的相关因素包括主动脉瘘（OR，12.31）和年龄增长（OR，1.06）。
急性主动脉综合征具有显著的早期和晚期死亡率。紧急血管内修复提供了一种微创治疗选择，具有可接受的短期和中期结果。由于在整个随访期间仍会发生二次手术和与主动脉相关的死亡，因此需要持续监测。
