Väärämäki Suvi, Suominen Velipekka, Pimenoff Georg, Saarinen Jukka, Uurto Ilkka, Salenius Juha
Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland School of Medicine, Tampere University, Tampere, Finland Seinäjoki Central Hospital, Seinäjoki, Finland
Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland School of Medicine, Tampere University, Tampere, Finland.
Vasc Endovascular Surg. 2016 Oct;50(7):491-496. doi: 10.1177/1538574416665969. Epub 2016 Sep 7.
To report our long-term experience in using the hybrid technique in complex thoracoabdominal aortic aneurysms (TAAAs).
Between March 2005 and September 2013, 10 patients with TAAA underwent hybrid procedures with open renovisceral revascularization and thoracoabdominal aortic endografting. Patients were analyzed retrospectively.
Six men and 4 women with a mean age of 66 years (range 54-81 years) were treated electively during the study period. All 4 visceral vessels were revascularized in 8 patients, whereas 1 patient underwent 3-vessel revascularization and another 2-vessel revascularization. The primary technical success rate was 100%. Eight of the procedures were single staged, and the 2 most recent cases were performed in 2 stages. Perioperative and 30-day mortality was 0%. The mean follow-up was 55 months (4-133 months). None of the patients died due to aortic complications. Major complications included paraplegia (10%, n = 1) and bowel ischemia (n = 1). Postoperative cerebrospinal fluid (CSF) pressure and mean arterial pressure measurements were systematically monitored and corrected. The CSF drainage solved another 4 cases of paraparesis. Three patients required postoperative dialysis, but none of them required permanently. Postoperative spinal cord ischemia and renal complications accumulated in extensive TAAA cases. One renal graft was occluded 45 days after the initial procedure but was successfully treated with thrombolysis. One type I and 1 type III endoleak were noted and successfully treated with an additional stent graft. Two cases of type II endoleak were detected-one with a growing aneurysm sac was treated successfully and another showed no growth and further procedures were abandoned after 2 embolization attempts. In long-term follow-up, 90% of the aneurysms showed shrinkage by a mean of 23 mm (range 7-45 mm).
The results of hybrid repair on high-risk patients with complex TAAAs are encouraging, and this approach is a valuable alternative when branched and fenestrated endovascular techniques are not considered an option.
报告我们在复杂胸腹主动脉瘤（TAAA）中使用杂交技术的长期经验。
2005年3月至2013年9月期间，10例TAAA患者接受了开放肾血管重建和胸腹主动脉腔内修复的杂交手术。对患者进行回顾性分析。
研究期间，6例男性和4例女性患者接受了择期治疗，平均年龄66岁（范围54 - 81岁）。8例患者的所有4支内脏血管均实现了血运重建，1例患者接受了3支血管血运重建，另1例接受了2支血管血运重建。主要技术成功率为100%。8例手术为一期完成，最近2例分两期进行。围手术期及30天死亡率为0%。平均随访55个月（4 - 133个月）。无患者因主动脉并发症死亡。主要并发症包括截瘫（10%，n = 1）和肠缺血（n = 1）。对术后脑脊液（CSF）压力和平均动脉压进行了系统监测和纠正。脑脊液引流解决了另外4例轻瘫病例。3例患者术后需要透析，但均无需长期透析。广泛TAAA病例中术后脊髓缺血和肾脏并发症有所累积。1例肾移植在初次手术后45天发生闭塞，但经溶栓治疗成功。发现1例I型和1例III型内漏，并通过额外的覆膜支架成功治疗。检测到2例II型内漏，1例伴有动脉瘤囊增大的患者治疗成功，另1例未见增大，在2次栓塞尝试后放弃进一步手术。在长期随访中，90%的动脉瘤平均缩小23 mm（范围7 - 45 mm）。
杂交修复复杂TAAA高危患者的结果令人鼓舞，当分支和开窗血管内技术不可行时，这种方法是一种有价值的选择。
Zotero 插件