Gloviczki P, Pairolero P, Welch T, Cherry K, Hallett J, Toomey B, Naessens J, Orszulak T, Schaff H
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905.
J Vasc Surg. 1990 Jan;11(1):19-27; discussion 27-8. doi: 10.1067/mva.1990.16620.
During the past 2 decades 102 consecutive patients (77 men and 25 women) with multiple aortic aneurysms underwent 201 aortic reconstructions. These procedures (174 elective and 27 emergent) represented 3.4% of the 5837 aortic aneurysm operations performed. Seventy-five (30.9%) of the 243 aneurysms occurred in the infrarenal aorta, 65 occurred in the descending aorta (26.7%), 56 occurred in the thoracoabdominal aorta (23.0%), and 47 occurred in the ascending aorta or arch (19.3%). Ages ranged from 20 to 81 years (mean 63.3 years). Smoking history and abnormal electrocardiographic tracings were present in 84.3% of the patients, hypertension was present in 77.5%, and obstructive lung disease was present in 60.8%. Multiple aortic aneurysms were present at the time of the first repair in 55 patients (53.9%). Twelve patients had one procedure, 81 had two, and nine had three. Sixteen (17.8%) of the 90 patients who had multiple operations had a subsequent operation for complications of the unrepaired aneurysm (rupture 12, symptoms 4). Fourteen perioperative deaths occurred among the 174 elective repairs (8.0%), and 11 occurred among the 27 emergent procedures (40.7%). Procedure mortality increased with the ordinal number of elective operations and was 4.4% for the first, 10.4% for the second, and 33.3% for the third. Seven of 21 patients (33.3%) who had simultaneous repair of at least two aortic aneurysms died in the perioperative period. Overall, 77 of the 102 patients (75.5%) survived all surgical procedures to repair their multiple aortic aneurysms; of these, 63 had complete resection of all known aneurysms. Follow-up was complete in all patients and averaged 6.3 years (ranges: 1 month to 19 years). There were 30 late deaths; the most frequent cause was myocardial infarction. Kaplan-Meier 5-year survival including perioperative deaths for all patients after the first operation was 76% and after the last operation 40%. We conclude that multiple aortic aneurysms can be safely managed, usually with staged repairs, and that long-term survival is probably. After the first aortic operation the presence of multiple aneurysms mandates close observation with timely surgical intervention.
在过去20年中，102例连续的多发主动脉瘤患者（77例男性和25例女性）接受了201次主动脉重建手术。这些手术（174例择期手术和27例急诊手术）占所进行的5837例主动脉瘤手术的3.4%。243个动脉瘤中，75个（30.9%）发生在肾下腹主动脉，65个发生在降主动脉（26.7%），56个发生在胸腹主动脉（23.0%），47个发生在升主动脉或主动脉弓（19.3%）。年龄范围为20至81岁（平均63.3岁）。84.3%的患者有吸烟史且心电图异常，77.5%的患者有高血压，60.8%的患者有阻塞性肺病。55例患者（53.9%）在首次修复时就存在多发主动脉瘤。12例患者接受了1次手术，81例接受了2次手术，9例接受了3次手术。在接受多次手术的90例患者中，16例（17.8%）因未修复的动脉瘤并发症（12例破裂，4例有症状）而接受了后续手术。174例择期修复手术中有14例围手术期死亡（8.0%），27例急诊手术中有11例死亡（40.7%）。手术死亡率随择期手术序数增加而升高，首次手术为4.4%，第二次为10.4%，第三次为33.3%。21例同时修复至少两个主动脉瘤的患者中有7例（33.3%）在围手术期死亡。总体而言，102例患者中有77例（75.5%）在所有修复多发主动脉瘤的手术中存活；其中，63例患者的所有已知动脉瘤均被完全切除。所有患者均完成随访，平均随访6.3年（范围：1个月至19年）。有30例晚期死亡；最常见的原因是心肌梗死。包括首次手术后围手术期死亡的所有患者的Kaplan-Meier 5年生存率为76%，最后一次手术后为40%。我们得出结论，多发主动脉瘤通常可通过分期修复安全处理，且可能实现长期存活。在首次主动脉手术后，多发动脉瘤的存在需要密切观察并及时进行手术干预。
