Dhillon J S, Randhawa G K, Straehley C J, McNamara J J
Circulation. 1986 Sep;74(3 Pt 2):I11-4.
We reviewed the entire experience in Hawaii with external wall reinforcement with Dacron graft material as a primary method of surgical treatment of aortic aneurysm. Over the past 11.5 years, 14 such procedures have been performed. Two of the aneurysms were located in the distal aortic arch, eight in the descending thoracic aorta, and four in the abdominal aorta. The operation was done in each instance as a safer alternative to resection and replacement in high-risk patients. There were two postoperative deaths, one unrelated to the surgery. To date, three of the 12 surviving patients have experienced aortic rupture at the graft site, 6 months to 3 years later. Two died of exsanguinating hemorrhage and a third survived corrective surgery. The rupture in each instance occurred through the entire wrap itself. Two of these developed aortobronchial fistulas and one an aortoesophageal fistula. The high incidence of late rupture of wrapped aneurysms, as reported here, has not been documented in the literature and raises serious questions as to the efficacy of this procedure.
我们回顾了在夏威夷采用涤纶移植材料进行外壁加固作为主动脉瘤外科治疗主要方法的全部经验。在过去的11.5年里，共进行了14例此类手术。其中2例动脉瘤位于主动脉弓远端，8例位于胸降主动脉，4例位于腹主动脉。在每种情况下，该手术都是作为高危患者切除和置换手术的更安全替代方案进行的。术后有2例死亡，其中1例与手术无关。迄今为止，12例存活患者中有3例在术后6个月至3年出现移植部位主动脉破裂。2例死于失血性出血，第3例在接受矫正手术后存活。每次破裂均发生在整个包裹物本身。其中2例形成了主动脉支气管瘘，1例形成了主动脉食管瘘。如本文所报道的，包裹性动脉瘤晚期破裂的高发生率在文献中尚无记载，这对该手术的疗效提出了严重质疑。
