Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, 3400 Spruce St, 6th Floor Silverstein Pavilion, Philadelphia, PA 19096, USA.
J Thorac Cardiovasc Surg. 2012 Sep;144(3):604-9; discussion 609-11. doi: 10.1016/j.jtcvs.2012.05.049.
Thoracic endovascular aortic repair (TEVAR) has become a widely established treatment for a variety of thoracic aortic pathologic diseases despite limited long-term data to support its use. We compared the long-term outcomes of TEVAR with the 3 commercially available stents grafts for thoracic aortic aneurysms to results in control subjects undergoing open surgery.
Demographic, clinical radiographic parameters were collected prospectively on patients enrolled in trials assessing the Gore TAG (55), Medtronic Talent (36) and Cook TX2 (15) devices. Outcomes were compared with 45 contemporaneous open controls. Detailed clinical and radiographic information was available for analysis. Standard univariate, survival, and regression methods were used.
During the study period (1995-2007) 106 patients were enrolled in TEVAR trials and there were 45 open controls. TEVAR patients were older and had significantly more comorbidities including diabetes and renal failure. TEVAR patients had 2.3 ± 1.3 devices implanted. Mortality (2.6% TEVAR, 6.7% open; P = .1), paralysis/paraparesis (3.9% TEVAR, 7.1% open; P = .2), and prolonged intubation more than 24 hours (9% TEVAR, 24% open; P = .02) tended to be more common in the open controls. Overall survival at 10 years was similar between groups (log rank P = .5). Multivariate predictors of late mortality included age, chronic obstructive pulmonary disease, diabetes, and chronic renal failure. Use of TEVAR versus open surgery did not influence mortality (hazard ratio, 0.9 95% confidence interval, 0.4-1.6). Over 5 years of radiographic follow-up in the TEVAR group, mean aortic diameter decreased from 61 to 55 mm. Freedom from reintervention on the treated segment was 85% in TEVAR patients at 10 years.
TEVAR is a safe and effective procedure to treat thoracic aortic aneurysms with improved perioperative and similar long-term results as open thoracic aortic repair. TEVAR-treated aneurysm diameters initially decrease and then stabilize over time.
尽管关于胸主动脉血管内修复术（TEVAR）的长期数据有限，但它已成为治疗多种胸主动脉病变的广泛应用的治疗方法。我们比较了 TEVAR 与 3 种市售的胸主动脉瘤支架移植物的长期结果，以及接受开放手术的对照组的结果。
前瞻性收集参加评估 Gore TAG（55 例）、美敦力 Talent（36 例）和 Cook TX2（15 例）装置的临床试验的患者的人口统计学、临床影像学参数。将结果与 45 例同期的开放对照组进行比较。详细的临床和影像学信息可供分析。采用标准的单变量、生存和回归方法。
在研究期间（1995-2007 年），共有 106 例患者参加了 TEVAR 试验，并有 45 例开放对照组。TEVAR 患者年龄较大，合并症更多，包括糖尿病和肾功能衰竭。TEVAR 患者植入了 2.3±1.3 个器械。死亡率（TEVAR 组 2.6%，开放组 6.7%；P=0.1）、瘫痪/截瘫（TEVAR 组 3.9%，开放组 7.1%；P=0.2）和延长插管超过 24 小时（TEVAR 组 9%，开放组 24%；P=0.02）在开放对照组中更为常见。两组 10 年总体生存率相似（对数秩检验 P=0.5）。晚期死亡的多变量预测因素包括年龄、慢性阻塞性肺疾病、糖尿病和慢性肾功能衰竭。与开放手术相比，TEVAR 的使用并未影响死亡率（风险比，0.9；95%置信区间，0.4-1.6）。在 TEVAR 组的 5 年影像学随访中，主动脉直径从 61 毫米降至 55 毫米。TEVAR 患者 10 年时治疗节段的无再干预率为 85%。
TEVAR 是一种安全有效的治疗胸主动脉瘤的方法，其围手术期效果改善，与开放胸主动脉修复的长期结果相似。TEVAR 治疗后的动脉瘤直径最初减小，然后随时间稳定。
