曾接受开放性主动脉手术患者的胸主动脉腔内修复术。
Thoracic endovascular aortic repair in patients with prior open aortic surgery.
作者信息
Shimizu Hideyuki, Yoshitake Akihiro, Kawaguchi Satoshi, Kawaguchi Shinji, Takaki Hidenobu, Yozu Ryohei
机构信息
Department of Cardiovascular Surgery, Keio University, Tokyo, Japan.
出版信息
Ann Vasc Dis. 2013;6(1):80-3. doi: 10.3400/avd.oa.12.00082. Epub 2013 Feb 28.
OBJECTIVE
To review our experience of thoracic endovascular aortic repair (TEVAR) in patients with prior open aortic repair (OAR).
MATERIALS AND METHODS
Stent-grafts were deployed in the arch, descending thoracic and thoracoabdominal aortae of 39, 13 and 5 patients, respectively, and in a deteriorated extra-anatomical prosthesis in one. The access route was the femoral artery in 10 of 23 patients with, and in 30 of 35 patients without a prior abdominal prosthesis. Prior prostheses and elephant trunks comprised 57 of 116 landing zones and 23 proximal landing zones, respectively.
RESULTS
Three patients died before discharge. Type II endoleaks developed in six patients, and Types I and III developed in one patient each. Type I endoleaks were not found at landing zones comprising prosthetic grafts. The overall actuarial three-year survival rate including early mortality was 86.5%.
CONCLUSION
The clinical outcomes of TEVAR were excellent, even in patients with prior OAR. Prosthetic grafts, including elephant trunks, provided good landing zones for TEVAR. Prostheses with larger-caliber designs are recommended for iliac artery reconstruction in future TEVAR.
目的
回顾我们对曾接受开放性主动脉修复术（OAR）的患者进行胸主动脉腔内修复术（TEVAR）的经验。
材料与方法
分别在39例、13例和5例患者的主动脉弓、降胸主动脉和胸腹主动脉中植入覆膜支架，1例植入功能恶化的解剖外人工血管。23例曾接受腹部人工血管植入术的患者中有10例、35例未接受腹部人工血管植入术的患者中有30例通过股动脉入路。先前植入的人工血管和象鼻支架分别占116个锚定区中的57个和23个近端锚定区。
结果
3例患者在出院前死亡。6例患者发生Ⅱ型内漏，1例患者发生Ⅰ型内漏，1例患者发生Ⅲ型内漏。在包含人工血管移植物的锚定区未发现Ⅰ型内漏。包括早期死亡率在内的总体三年精算生存率为86.5%。
结论
即使是曾接受OAR的患者，TEVAR的临床效果也很好。包括象鼻支架在内的人工血管移植物为TEVAR提供了良好的锚定区。建议在未来的TEVAR中采用大口径设计的人工血管进行髂动脉重建。
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