Minami Tomoyuki, Imoto Kiyotaka, Uchida Keiji, Karube Norihisa, Yasuda Shota, Choh Tomoki, Suzuki Shinichi, Masuda Munetaka
Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; Cardiovascular Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan.
J Card Surg. 2015 Feb;30(2):163-9. doi: 10.1111/jocs.12499. Epub 2014 Dec 29.
We evaluated clinical outcomes of thoracic endovascular aortic repair (TEVAR) for ruptured descending thoracic aortic aneurysm (rDTAA).
Twenty-three patients with rDTAA (mean age, 76.8 ± 8.8 years) underwent TEVAR at our center between January 2008 and April 2013.
In twenty-three patients, five patients (21.7%) were in shock before surgery. Technical success was achieved in 21 patients. After TEVAR, retrograde Type A aortic dissection occurred in one patient, Type I endoleak in one patient, and Type II endoleak in three patients. The 30-day mortality rate was 4.3% (n = 1), and there were five in-hospital deaths (21.7%). Six patients (26.1%) developed cerebral complications and two patients suffered from paraplegia. In the late phase, four patients died because of the following aortic events: re-rupture in one patient, rupture of another untreated aneurysm in two patients, and esophageal perforation in one patient.
TEVAR is associated with relatively low early morbidity and mortality and can be performed in older and high-risk patients. However, because aortic events during follow-up after TEVAR are not rare, we recommend close follow-up and application of early and aggressive reintervention.
我们评估了胸主动脉腔内修复术（TEVAR）治疗降主动脉瘤破裂（rDTAA）的临床结果。
2008年1月至2013年4月期间，23例rDTAA患者（平均年龄76.8±8.8岁）在我们中心接受了TEVAR治疗。
23例患者中，5例（21.7%）术前处于休克状态。21例患者手术技术成功。TEVAR术后，1例患者发生逆行A型主动脉夹层，1例患者发生I型内漏，3例患者发生II型内漏。30天死亡率为4.3%（n = 1），住院死亡5例（21.7%）。6例患者（26.1%）出现脑部并发症，2例患者发生截瘫。在后期，4例患者因以下主动脉事件死亡：1例患者再破裂，2例患者未治疗的另一个动脉瘤破裂，1例患者食管穿孔。
TEVAR的早期发病率和死亡率相对较低，可在老年和高危患者中进行。然而，由于TEVAR术后随访期间主动脉事件并不罕见，我们建议密切随访并尽早积极进行再次干预。
