Hu Haiou, Zheng Tie, Zhu Junming, Liu Yongmin, Qi Ruidong, Sun Lizhong
Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing 100029, China.
J Thorac Dis. 2017 Jan;9(1):64-69. doi: 10.21037/jtd.2017.01.54.
The surgical treatment of Crawford extent II aneurysms after thoracic endovascular aortic repair (TEVAR) remains challenging, because of the need to remove the failed endograft and the complexity of the aortic reconstruction. We retrospectively reviewed our experience with surgical management of Crawford extent II aneurysms after TEVAR using thoracoabdominal aortic replacement (TAAR).
Eleven patients (10 males, 1 female) with Crawford extent II aneurysm after TEVAR were treated with TAAR between August 2012 and May 2015. The indications included: diameter >5.0 cm; persistent pain; size increase >0.5 cm/year; and no suitable landing zone for re-TEVAR. Five patients underwent surgery under deep hypothermic cardiac arrest, two under mild hypothermic cardiopulmonary bypass, and four under direct aortic cross-clamping under normothermia. Two patients had Marfan syndrome.
There were no in-hospital deaths. Continuous renal replacement therapy was required in three patients. One patient needed re-intubation, and two patients had prolonged intubation (>72 h). One patient sustained paraplegia after surgery but recovered during follow-up. Cerebrospinal fluid drainage were used in four patients (3 immediately in the operation room, and 1 in the intensive care unit when the patient suffered paraplegia). One patient died during follow-up.
TAAR represents a feasible option for the treatment of Crawford extent II aneurysms after TEVAR, with acceptable surgical risks and favorable results.
胸主动脉腔内修复术（TEVAR）后CrawfordⅡ型动脉瘤的外科治疗仍然具有挑战性，因为需要移除失败的血管内移植物以及主动脉重建的复杂性。我们回顾性分析了我们采用胸腹主动脉置换术（TAAR）治疗TEVAR术后CrawfordⅡ型动脉瘤的经验。
2012年8月至2015年5月期间，11例（10例男性，1例女性）TEVAR术后CrawfordⅡ型动脉瘤患者接受了TAAR治疗。适应证包括：直径>5.0 cm；持续疼痛；大小每年增加>0.5 cm；以及没有适合再次TEVAR的锚定区。5例患者在深低温心脏停搏下接受手术，2例在浅低温体外循环下接受手术，4例在常温下直接主动脉交叉钳夹下接受手术。2例患者患有马凡综合征。
无住院死亡病例。3例患者需要持续肾脏替代治疗。1例患者需要再次插管，2例患者插管时间延长（>72小时）。1例患者术后发生截瘫，但在随访期间恢复。4例患者使用了脑脊液引流（3例在手术室立即使用，1例在重症监护病房患者发生截瘫时使用）。1例患者在随访期间死亡。
TAAR是治疗TEVAR术后CrawfordⅡ型动脉瘤的一种可行选择，具有可接受的手术风险和良好的效果。
