Choi Jae-Sung, Oh Se Jin, Sung Yong Won, Moon Hyun Jong, Lee Jung Sang
Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center.
Korean J Thorac Cardiovasc Surg. 2016 Apr;49(2):73-9. doi: 10.5090/kjtcs.2016.49.2.73. Epub 2016 Apr 5.
The aim of this study was to report our early experiences with the endovascular repair of ruptured descending thoracic aortic aneurysms (rDTAAs), which are a rare and life-threatening condition.
Among 42 patients who underwent thoracic endovascular aortic repair (TEVAR) between October 2010 and September 2015, five patients (11.9%) suffered an rDTAA.
The mean age was 72.4±5.1 years, and all patients were male. Hemoptysis and hemothorax were present in three (60%) and two (40%) patients, respectively. Hypovolemic shock was noted in three patients who underwent emergency operations. A hybrid operation was performed in three patients. The mean operative time was 269.8±72.3 minutes. The mean total length of aortic coverage was 186.0±49.2 mm. No 30-day mortality occurred. Stroke, delirium, and atrial fibrillation were observed in one patient each. Paraplegia did not occur. Endoleak was found in two patients (40%), one of whom underwent an early and successful reintervention. During the mean follow-up period of 16.8±14.8 months, two patients died; one cause of death was a persistent type 1 endoleak and the other cause was unknown.
TEVAR for rDTAA was associated with favorable early mortality and morbidity outcomes. However, early reintervention should be considered if persistent endoleak occurs.
本研究的目的是报告我们对破裂性降主动脉瘤（rDTAAs）进行血管内修复的早期经验，rDTAAs是一种罕见且危及生命的疾病。
在2010年10月至2015年9月期间接受胸主动脉腔内修复术（TEVAR）的42例患者中，有5例（11.9%）患有rDTAA。
平均年龄为72.4±5.1岁，所有患者均为男性。咯血和血胸分别出现在3例（60%）和2例（40%）患者中。3例接受急诊手术的患者出现了低血容量性休克。3例患者接受了杂交手术。平均手术时间为269.8±72.3分钟。主动脉覆盖的平均总长度为186.0±49.2毫米。无30天死亡率。分别有1例患者出现中风、谵妄和心房颤动。未发生截瘫。2例患者（40%）发现内漏，其中1例早期成功进行了再次干预。在平均16.8±14.8个月的随访期内，2例患者死亡；1例死亡原因是持续性I型内漏，另1例死亡原因不明。
rDTAA的TEVAR与良好的早期死亡率和发病率结果相关。然而，如果发生持续性内漏，应考虑早期再次干预。
