Rosenblum Joshua M, Chen Edward P
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Gen Thorac Cardiovasc Surg. 2019 Jan;67(1):175-179. doi: 10.1007/s11748-017-0820-y. Epub 2017 Aug 30.
Successful repair of complex thoracoabdominal aortic aneurysms requires careful surgical planning based on anatomic and patient considerations. Not only are surgical considerations key, but also post-operative care, regardless of surgical approach, can dramatically impact both short- and long-term outcomes. While open repair has been the gold standard for decades, the technical challenges associated with operative repair, a specialty approach requisite for good outcomes, and the unique challenges in the post-operative care of these patients have given providers pause when considering operative intervention. The relatively recent development of elegant endovascular and hybrid approaches to this problem has shown improved short-term morbidity and reasonable durability. Here, we discuss these three techniques for correction of complex thoracoabdominal aortic aneurysms to provide some guidance for optimization of outcomes based on individual patient anatomy and comorbid conditions.
成功修复复杂胸腹主动脉瘤需要基于解剖结构和患者情况进行仔细的手术规划。不仅手术考量至关重要，而且无论采用何种手术方式，术后护理对短期和长期预后都可能产生重大影响。尽管开放修复几十年来一直是金标准，但与手术修复相关的技术挑战、良好预后所需的专科手术方法以及这些患者术后护理中的独特挑战，都让医疗人员在考虑手术干预时有所犹豫。针对这一问题，相对较新出现的精妙的血管内修复和杂交修复方法已显示出短期发病率降低且耐久性合理。在此，我们讨论这三种用于矫正复杂胸腹主动脉瘤的技术，以便根据个体患者的解剖结构和合并症为优化预后提供一些指导。
