Canaud Ludovic, Alric Pierre
CHU de Montpellier, hôpital Arnaud-de-Villeneuve, service de chirurgie thoracique et vasculaire, 191, avenue Doyen-Gaston-Giraud, 34090 Montpellier, France.
CHU de Montpellier, hôpital Arnaud-de-Villeneuve, service de chirurgie thoracique et vasculaire, 191, avenue Doyen-Gaston-Giraud, 34090 Montpellier, France.
Presse Med. 2018 Feb;47(2):153-160. doi: 10.1016/j.lpm.2017.12.004. Epub 2018 Feb 23.
Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was readily apparent, as it avoided left thoracotomy, aortic cross-clamping, and left heart bypass. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution. Since then, TEVAR is increasingly being used for other aortic pathologies such as complicated type B dissection, traumatic aortic transection, and aneurysmal disease extending into the arch or visceral segment, requiring debranching procedures.
胸主动脉退行性动脉瘤的患病率正在上升。与开放修复相比,这种方法的发病率降低,这一点很明显,因为它避免了左胸切开术、主动脉交叉钳夹和左心旁路。1995年引入了使用支架移植物修复孤立性降胸主动脉瘤的方法,在胸主动脉瘤解剖结构合适的亚组患者中,血管内支架移植物修复可提供良好的结果,与开放修复相比,围手术期发病率和死亡率降低。成功进行胸主动脉腔内修复术的基石是合适的患者选择、全面的术前规划和谨慎的手术执行。从那时起,TEVAR越来越多地用于其他主动脉病变,如复杂的B型夹层、创伤性主动脉横断以及延伸至主动脉弓或内脏段的动脉瘤性疾病,这些需要进行去分支手术。