Synowiec Tomasz, Chęciński Paweł, Samolewski Przemysław, Zieliński Wojciech, Konik-Piński Daniel, Kuczmarska Angelika
Department of General and Vascular Surgery and Angiology, Poznan University of Medical Sciences, Poland.
Wideochir Inne Tech Maloinwazyjne. 2012 Jun;7(2):132-6. doi: 10.5114/wiitm.2011.26765. Epub 2012 Jan 26.
Open repair of thoracoabdominal aortic aneurysm is connected with high mortality and morbidity. On the other hand, endovascular treatment of thoraco-abdominal aneurysms, which started 10 years ago, reduced perioperative mortality and morbidity. However, it results in a high level of late complications. It seems that an interesting solution to the problem is a hybrid procedure, which allows late complications to be reduced with acceptable levels of operative mortality and morbidity. This case report presents the use of a hybrid procedure in treatment of symptomatic thoraco-abdominal aneurysm in a patient with prior abdominal aortic reconstruction. In the first stage the patient underwent open revascularization of visceral vessels of the aorta. One week later a thoraco-abdominal stent-graft was implanted. The perioperative and postoperative period was uncomplicated. Two months after the second intervention the patient returned to work. Control imaging conducted 30 and 90 days after the procedure confirmed patency of all revascularized vessels and did not reveal any graft-related complications. The hybrid procedure seems to be an interesting alternative for open and endovascular repair of thoraco-abdominal aneurysms because it combines the advantages of open and endovascular repair. It also gives an opportunity to perform the procedure within a reasonable period of time from diagnosis of symptomatic thoraco-abdominal aneurysm.
胸腹主动脉瘤开放修复术与高死亡率和高发病率相关。另一方面，始于10年前的胸腹主动脉瘤血管内治疗降低了围手术期死亡率和发病率。然而，它会导致较高水平的晚期并发症。似乎解决该问题的一个有趣方法是杂交手术，该手术能在可接受的手术死亡率和发病率水平下减少晚期并发症。本病例报告展示了杂交手术在一名曾行腹主动脉重建术的患者中治疗有症状胸腹主动脉瘤的应用。在第一阶段，患者接受了主动脉内脏血管的开放血运重建。一周后植入了胸腹主动脉覆膜支架。围手术期和术后过程均无并发症。第二次干预后两个月患者恢复工作。术后30天和90天进行的对照影像学检查证实了所有血运重建血管的通畅，且未发现任何与移植物相关的并发症。杂交手术似乎是胸腹主动脉瘤开放修复术和血管内修复术的一个有趣替代方案，因为它结合了开放修复术和血管内修复术的优点。它还为在诊断有症状胸腹主动脉瘤后的合理时间内进行该手术提供了机会。
