Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, United Kingdom.
Eur J Vasc Endovasc Surg. 2012 Mar;43(3):262-7. doi: 10.1016/j.ejvs.2011.11.009. Epub 2011 Dec 23.
Endovascular graft designs incorporating sidebranches, fenestrations and scallops offer a minimally-invasive alternative to open surgery and hybrid approaches for thoracoabdominal aortic aneurysms (TAAA). Our unit has offered total endovascular TAAA repair to selected higher-risk patients since 2008. We report the largest UK series to date of total endovascular TAAA repair.
Retrospective analysis of a prospectively-maintained operative database.
31 patients (21 male, 10 female) median age 71 years (range 58-84), with TAAA (12 Crawford type I, 13 type III, 6 type IV), median diameter 6.4 (4.3 (mycotic)- 9.9) underwent endovascular TAAA repair (total 48 sidebranches, 26 fenestrations, 13 scallops) between July 2008 and January 2011. Median operating time 225 min (65-540 min), X-ray screening time 58 min (4-212 min), contrast dose 175 ml (70-500 ml), blood loss 325 ml (100-400 ml). Median post-operative length of hospital stay 6 days (2-22 days). Three patients (3/31, 9.7%) died within 30 days of operation: multisystem organ failure (1) acute renal failure and paraplegia (1) and paraplegia (1). There were no other cases of in-hospital organ failure, paraplegia or major complications. The median change in pre-discharge from pre-operative renal function was 3.4% deterioration in eGFR (range: 32.7% deterioration to 73.0% improvement) One patient presented with late-onset paraparesis, a second developed acute renal failure 8 months after repair. One early high-pressure endoleak (type 3) required correction. Three patients had died by median follow-up 12 months (1-36), 2 from heart disease and one from haemopericardium secondary to acute dissection of the ascending aorta (the dissection did not involve, nor extend close to, the endovascular graft).
Total endovascular repair of TAAA offers patients a minimally-invasive alternative to open surgery with early results at least comparable to those seen with open or hybrid surgical approaches.
带分支、开窗和扇贝型的血管内移植物设计为胸主动脉腹主动脉瘤（TAAA）提供了一种微创的替代开放手术和杂交手术的方法。自 2008 年以来，我们单位一直为选定的高危患者提供全腔内 TAAA 修复。我们报告了迄今为止英国最大的全腔内 TAAA 修复系列。
回顾性分析前瞻性维护的手术数据库。
31 名患者（21 名男性，10 名女性），中位年龄 71 岁（范围 58-84 岁），TAAA（12 例 Crawford Ⅰ型，13 例Ⅲ型，6 例Ⅳ型），中位直径 6.4（4.3（感染性）-9.9）在 2008 年 7 月至 2011 年 1 月期间接受了全腔内 TAAA 修复（总共 48 个分支，26 个开窗，13 个扇贝）。中位手术时间 225 分钟（65-540 分钟），X 线筛查时间 58 分钟（4-212 分钟），造影剂剂量 175ml（70-500ml），失血量 325ml（100-400ml）。中位术后住院时间为 6 天（2-22 天）。3 名患者（3/31，9.7%）在术后 30 天内死亡：多器官功能衰竭（1 例）、急性肾衰竭和截瘫（1 例）和截瘫（1 例）。没有其他院内器官衰竭、截瘫或主要并发症的病例。出院前肾功能的中位变化为 eGFR 恶化 3.4%（范围：32.7%恶化至 73.0%改善）。1 例患者出现迟发性截瘫，另 1 例患者在修复后 8 个月出现急性肾衰竭。1 例早期高压内漏（3 型）需要纠正。中位随访 12 个月（1-36 个月）时，3 名患者死亡，2 名死于心脏病，1 名死于急性升主动脉夹层引起的心包积血（夹层未累及或接近血管内移植物）。
全腔内 TAAA 修复为患者提供了一种微创的替代开放手术的方法，其早期结果至少与开放或杂交手术方法相当。
