Rosset E, Ben Ahmed S, Galvaing G, Favre J P, Sessa C, Lermusiaux P, Hassen-Khodja R, Coggia M, Haulon S, Rinckenbach S, Enon B, Feugier P, Steinmetz E, Becquemin J P
CHU Clermont-Ferrand, France.
CHU Clermont-Ferrand, France.
Eur J Vasc Endovasc Surg. 2014 May;47(5):470-8. doi: 10.1016/j.ejvs.2014.02.013. Epub 2014 Mar 19.
The aim of this study was to assess the results of hybrid techniques for the treatment of thoracic, thoracoabdominal, and abdominal aortic aneurysms based on multicenter results and the various series regarding hybrid procedures reported in the literature.
The results of 76 hybrid procedures performed in 19 French university hospital centers between November 2001 and October 2011 were collected. There were 50 men and 26 women, mean age 68.2 (35-86) years. All patients were considered at high risk (ASA≥3) for conventional surgery. Aneurysms involved the thoracic, abdominal, and thoracoabdominal aorta in five, 14, and 57 cases respectively. There were 11 emergent repairs. The revascularization of four visceral arteries was performed in 38 cases. Between one and three visceral arteries were revascularized in the other cases. Visceral artery debranching and stent graft deployment were performed in a one-stage procedure in 53 cases and in a two-stage procedure in 23 cases.
There were 26 (34.2%) postoperative deaths. Nine of the survivors developed paraplegia, of which one resolved completely. Bowel ischemia occurred in 13 cases (17.1%), and one patient was treated by a superior mesenteric artery bypass. Four patients required long-term hemodialysis. Postoperative computed tomography scan showed a type II endoleak in two patients.
Morbidity and mortality in this study were greater than previously reported. Candidates for hybrid aortic repair should be carefully selected.
本研究旨在基于多中心结果以及文献中报道的关于杂交手术的各种系列研究，评估杂交技术治疗胸主动脉、胸腹主动脉和腹主动脉瘤的效果。
收集了2001年11月至2011年10月期间在19家法国大学医院中心进行的76例杂交手术的结果。其中男性50例，女性26例，平均年龄68.2岁（35 - 86岁）。所有患者均被认为进行传统手术的风险较高（美国麻醉医师协会分级≥3级）。动脉瘤累及胸主动脉、腹主动脉和胸腹主动脉的病例分别为5例、14例和57例。有11例急诊修复手术。38例患者对四条内脏动脉进行了血运重建。其他病例中对一至三条内脏动脉进行了血运重建。53例患者采用一期手术进行内脏动脉去分支和支架移植物置入，23例患者采用二期手术。
术后死亡26例（34.2%）。9名幸存者发生截瘫，其中1例完全恢复。13例发生肠缺血（17.1%），1例患者接受了肠系膜上动脉搭桥治疗。4例患者需要长期血液透析。术后计算机断层扫描显示2例患者存在Ⅱ型内漏。
本研究中的发病率和死亡率高于先前报道。杂交主动脉修复手术的候选患者应谨慎选择。
