Department of Vascular Surgery, Vita-Salute University School of Medicine, San Raffaele Scientific Institute, Milan, Italy.
Università Cattolica del S. Cuore, Istituto di Patologia Chirurgica, Fondazione "Policlinico Universitario A. Gemelli", Polo Scienze Cardiovascolari e Toraciche, Rome, Italy.
J Vasc Surg. 2018 Apr;67(4):1017-1024. doi: 10.1016/j.jvs.2017.08.067. Epub 2017 Oct 19.
In the era of rising endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs), the analysis of visceral vessel (VV) patency after open surgical repair is crucial to provide a future benchmark between these different approaches. This study reports the late outcomes of a single-center experience with open TAAA repair, focusing on the results of different techniques adopted for renal and splanchnic revascularization.
Data were analyzed for 382 consecutive open TAAA repairs performed between January 2009 and July 2015 (284 men; mean age, 66 ± 10 years). Follow-up of surviving patients was carried out by computed tomography angiography and office checkups at 3 and 12 months and yearly afterward. Kaplan-Meier analysis was performed for overall survival, patency of reconstructed VVs (celiac trunk, superior mesenteric artery, right renal artery, left renal artery), and reinterventions on visceral arteries. Furthermore, VV long-term patency was analyzed in subgroups of patients according to the revascularization strategy (patch inclusion of all vessels, group 1; one-vessel separate reattachment and patch inclusion of the remaining vessels, group 2; separate reattachment of all VVs, group 3).
In-hospital mortality and paraparesis/paraplegia occurred in 7.6% and 8.1% of patients, respectively. Among the 353 survivors, 338 complied with the follow-up protocol, and adequate computed tomography angiography images were available in 247 patients (952 VVs were analyzed). Overall follow-up survival was 94%, 91%, and 70% at 1 year, 2 years, and 5 years, respectively. At the same time points, VV patency was 99%, 98%, and 98% for celiac trunk; 100%, 100%, and 100% for superior mesenteric artery; 100%, 96%, and 96% for right renal artery; and 91%, 87%, and 82% for left renal artery (log-rank test, P < .0001). Estimates for reinterventions on VVs were 1.2%, 6.3%, and 17% at the same time points. Freedom from occlusion of any VV at 1 year and 3 years was 95% and 87% for group 1, 89% and 79% for group 2, and 92% and 92% for group 3, respectively (log-rank test, P = .13).
Long-term patency of VVs after open TAAA repair performed in high-volume centers is high, regardless of the technique employed for revascularization. The left renal artery appears to be most prone to occlusion over time.
在胸主动脉瘤腔内治疗时代，开放手术修复后的内脏血管通畅性分析对于比较不同治疗方法至关重要。本研究报告了单中心开放胸主动脉瘤修复的长期结果，重点介绍了用于肾和内脏动脉再血管化的不同技术的结果。
分析了 2009 年 1 月至 2015 年 7 月期间连续 382 例接受开放胸主动脉瘤修复的患者数据（284 例男性；平均年龄 66±10 岁）。对存活患者进行随访，采用计算机断层血管造影术和门诊检查，分别在术后 3 个月、12 个月和之后每年进行一次。采用 Kaplan-Meier 分析法评估总体生存率、重建内脏血管（腹腔干、肠系膜上动脉、右肾动脉、左肾动脉）通畅率和内脏动脉再介入治疗。此外，根据再血管化策略（所有血管均包含补片，组 1；对剩余血管分别进行再附着和补片，组 2；对所有内脏血管分别进行再附着，组 3）对内脏血管的长期通畅率进行了亚组分析。
住院死亡率和截瘫/下肢瘫痪分别为 7.6%和 8.1%。在 353 例存活患者中，338 例符合随访方案，247 例（952 条内脏血管）获得了足够的计算机断层血管造影图像。术后 1 年、2 年和 5 年的总随访生存率分别为 94%、91%和 70%。同时，腹腔干的血管通畅率分别为 99%、98%和 98%；肠系膜上动脉分别为 100%、100%和 100%；右肾动脉分别为 100%、96%和 96%；左肾动脉分别为 91%、87%和 82%（对数秩检验，P<0.0001）。同期，内脏血管再介入治疗的估计发生率分别为 1.2%、6.3%和 17%。1 年和 3 年时，任何内脏血管闭塞的无闭塞率分别为组 1 的 95%和 87%、组 2 的 89%和 79%以及组 3 的 92%和 92%（对数秩检验，P=0.13）。
在高容量中心进行开放胸主动脉瘤修复后，内脏血管的长期通畅率较高，无论再血管化采用何种技术。左肾动脉随着时间的推移似乎更容易发生闭塞。
