Department of Clinical and Interventional Radiology, Poznan University of Medical Sciences, Poznan, Poland.
Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland.
PLoS One. 2013 Dec 26;8(12):e83601. doi: 10.1371/journal.pone.0083601. eCollection 2013.
In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs.
This study involved 37 asymptomatic patients (26 female and 11 male) who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair.
Follow-up studies revealed TAA in seven cases (19%) (including six with the gothic type of the aortic arch) and mild recoarctation in other six (16%). Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA), in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure.
The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch) that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary.
在一些患者中，主动脉缩窄手术后多年才会出现与局部手术相关的并发症。本研究的目的是：（1）系统评估儿童期涤纶补丁修复后无症状的成年患者，（2）评估继发性胸主动脉瘤（TAAs）的形成率，以及（3）评估 TAAs 血管内治疗后的结局。
本研究纳入 37 名（26 名女性，11 名男性）儿童期主动脉缩窄手术修复后无症状的成年患者。进入青春期后，患有继发性 TAAs 的患者被转诊至血管内修复。
随访研究显示 7 例（19%）患者存在 TAA（包括 6 例主动脉弓呈哥特式形态）和另外 6 例（16%）轻度再狭窄。6 例 TAA 患者接受了支架移植物治疗，但有 1 例拒绝进行血管内手术。3 例支架移植物覆盖了左锁骨下动脉（LSA），另 1 例支架移植物植入 LSA 远端。2 例患者接受了择期杂交手术，即对升主动脉进行旁路手术，然后植入支架移植物。所有患者均在二次手术后存活。1 例患者在植入支架移植物后发生 Ia 型内漏，最终采用去分支手术治疗。
在主动脉缩窄补丁修复后无症状的成年患者中，其长期病程并不少见会出现 TAAs（特别是主动脉弓呈哥特式形态的患者）形成，可通过支架移植物有效治疗。然而，在一些患者中，可能需要进行杂交手术。
