Montgomery Jennifer P, Kolbeck Kenneth J, Kaufman John A
Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon.
Semin Intervent Radiol. 2015 Sep;32(3):249-58. doi: 10.1055/s-0035-1556879.
Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature.
破裂性主动脉瘤一律需要紧急处理。从历史上看，紧急手术修复或药物治疗是仅有的治疗选择。覆膜支架移植物的发展为这些重症患者的治疗引入了第三种方法。在大多数情况下，患者的临床状况和当地医生的专业知识决定了治疗方式。这些患者的治疗目标是尽快使患者病情稳定，实现最大程度的生存且将发病率降至最低，并获得持久的治疗效果。对于越来越多出现胸降主动脉和腹主动脉瘤破裂性疾病的患者而言，血管内治疗方法已成为一种可接受的治疗选择。影响治疗的主要因素包括患者临床状况、主动脉特征、医生偏好、机构经验以及合适设备的可获得性。当采用血管内技术时，规划、经验以及临时想出有效解决方案的能力是手术成功的关键。本文介绍了三个需要术中临时应变的病例，随后对相关文献进行了综述。
