Chen Tanghua, Crozier John A
Department of Vascular Surgery, Liverpool Hospital, Sydney, Australia.
Liverpool Hospital, Sydney, Australia.
J Vasc Nurs. 2014 Jun;32(2):63-9. doi: 10.1016/j.jvn.2013.07.001.
Endovascular stent grafting is increasingly used to manage descending thoracic aortic pathologies. The procedure was introduced at the study hospital in 2001. We sought to examine the short-term clinical outcomes of patients who underwent this endovascular stent grafting, with the aim of using the result as baseline for development of an in-center clinical management protocol. We undertook a single-center, retrospective review of health care records of patients managed with thoracic stent grafts from 2001 to 2009. Patient characteristics, in-hospital data, and procedural data were obtained. SPSS was used to analyze the data. A total of 30 patients were treated with thoracic stent; 23 were male, 7 were female, and the mean age was 55.0. Aortic pathologies treated were traumatic aortic dissection/transection (n = 15), acute/chronic aortic dissection (n = 9), and degenerative aneurysms (n = 6). Endoleak occurred in 3 patients, with 1 requiring further endograft repair. Two patients underwent combined open and endovascular repair of acute thoracic aortic dissection; 1 died 4 days after the procedure, and the other developed stroke and acute renal failure not requiring dialysis. Of the 28 patients who underwent endovascular repair, paraplegia and paraparesis occurred in 2 patients but resolved with cerebrospinal fluid drainage. Stroke occurred in 1 patient. Patients who underwent combined procedure of open and endovascular repair of thoracic aortic dissection had a greater risk of developing major adverse events than patients who underwent endovascular repair alone (Fisher's exact test P = .023). There was no association between the risk of stroke and the coverage of left subclavian artery in this series (P = .483). Graft stenting treatment for descending thoracic aortic pathologies has been shown to result in high in-hospital survival rates. It is essential for nurses who work in acute care settings to have knowledge of this procedure and potential complications associated with the procedure to enable postoperative assessment and immediate action if any deviation is observed.
血管内支架植入术越来越多地用于治疗胸降主动脉病变。该手术于2001年在研究医院引入。我们试图研究接受这种血管内支架植入术患者的短期临床结果，目的是将结果作为制定中心临床管理方案的基线。我们对2001年至2009年接受胸主动脉支架植入术治疗的患者的医疗记录进行了单中心回顾性研究。获取了患者特征、住院数据和手术数据。使用SPSS分析数据。共有30例患者接受了胸主动脉支架治疗；男性23例，女性7例，平均年龄55.0岁。治疗的主动脉病变包括创伤性主动脉夹层/横断（n = 15）、急性/慢性主动脉夹层（n = 9）和退行性动脉瘤（n = 6）。3例患者发生内漏，其中1例需要进一步进行腔内修复。2例患者接受了急性胸主动脉夹层的开放手术与血管内修复联合治疗；1例在术后4天死亡，另1例发生中风和急性肾衰竭但无需透析。在接受血管内修复的28例患者中，2例发生截瘫和轻瘫，但通过脑脊液引流得以缓解。1例患者发生中风。接受胸主动脉夹层开放手术与血管内修复联合治疗的患者发生主要不良事件的风险高于仅接受血管内修复的患者（Fisher精确检验P = .023）。本系列研究中，中风风险与左锁骨下动脉覆盖情况之间无相关性（P = .483）。胸降主动脉病变的移植物支架植入治疗已显示出较高的住院生存率。在急性护理环境中工作的护士必须了解该手术及与之相关的潜在并发症，以便进行术后评估，并在观察到任何偏差时能够立即采取行动。
