复杂胸腹主动脉病变急诊和紧急治疗的混合方法。

Hybrid approach to emergent and urgent treatment of complex thoracoabdominal aortic pathology.

作者信息

Gkremoutis A, Schmandra T, Meyn M, Schmitz-Rixen T, Keese M

机构信息

Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Frankfurt am Main, Germany.

出版信息

Eur J Vasc Endovasc Surg. 2014 Oct;48(4):407-13. doi: 10.1016/j.ejvs.2014.07.010. Epub 2014 Sep 2.

DOI:10.1016/j.ejvs.2014.07.010

PMID:25189829

Abstract

OBJECTIVES

The aim was to report a single center experience with hybrid procedures in the emergency treatment of patients with thoracoabdominal aortic pathology. Thoracoabdominal aortic aneurysm (TAAA) repair is primarily conducted by conventional surgery in the urgent and emergency setting. The role of hybrid procedures with stent graft coverage of the aorta and extra-anatomical debranching of the renovisceral arteries has so far not been defined in this context.

METHODS

From 2007 to 2013 30 patients (21 males, 9 females) undergoing an emergent or urgent TAAA hybrid procedure were included in a data register. The mean aneurysm diameter was 72 mm. Etiology was atherosclerosis in 23 patients (76.7%) and aortic dissection in seven patients (23.3%). Nineteen patients (63.3%) required emergency surgery. In 11 cases (36.7%), surgery was indicated for symptomatic aneurysms. Mean follow-up was 16 months (range 1-72 months).

RESULTS

The hybrid procedure was completed in all patients. Renovisceral revascularization was performed with a total of 101 grafts (25 to the celiac, 30 to the superior mesenteric, 25 to the right renal, and 21 to the left renal artery). The 30-day and 1-year primary graft patency was 97.3% and 95.3% respectively. A median of three stent grafts per patient was deployed. One patient underwent surgical intervention for early endoleak (3.3%). Three patients (10%) developed spinal ischemia with persistent paraplegia. Two patients (6.7%) required chronic hemodialysis. Thirty-day mortality reached 26.7% (N = 8), being 36.8% in emergency patients (7 of 19) and 9.1% in the urgent group (1 of 11 patients). The cumulative postoperative survival rate after 12 months was 57.8%.

CONCLUSIONS

Hybrid procedures have the potential to be an alternative treatment option for complex thoracoabdominal pathology in the urgent and emergency setting. The procedure is readily available and enables adequate surgical repair with enduring results. Nevertheless it is still associated with significant mortality and morbidity.

摘要

目的

本研究旨在报告单一中心采用杂交手术急诊治疗胸腹主动脉病变患者的经验。胸腹主动脉瘤（TAAA）修复术在紧急情况下主要通过传统手术进行。在这种情况下，采用主动脉覆膜支架置入术和肾动脉外解剖性分支杂交手术的作用至今尚未明确。

方法

2007年至2013年，30例（21例男性，9例女性）接受急诊或紧急TAAA杂交手术的患者被纳入数据登记。动脉瘤平均直径为72毫米。病因方面，23例（76.7%）为动脉粥样硬化，7例（23.3%）为主动脉夹层。19例（63.3%）患者需要急诊手术。11例（36.7%）患者因有症状的动脉瘤而接受手术。平均随访时间为16个月（范围1 - 72个月）。

结果

所有患者均完成杂交手术。共使用101根移植物进行肾动脉重建（25根至腹腔干，30根至上肠系膜动脉，25根至右肾动脉，21根至左肾动脉）。30天和1年的初级移植物通畅率分别为97.3%和95.3%。每位患者平均植入3个覆膜支架。1例患者因早期内漏接受手术干预（3.3%）。3例患者（10%）发生脊髓缺血并持续截瘫。2例患者（6.7%）需要长期血液透析。30天死亡率达26.7%（N = 8），急诊患者为36.8%（19例中的7例），紧急组为9.1%（11例中的1例）。12个月后的累计术后生存率为57.8%。