Maeda Koji, Ohki Takao, Kanaoka Yuji
Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
Int J Angiol. 2018 Jun;27(2):81-91. doi: 10.1055/s-0038-1645881. Epub 2018 May 7.
The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.
在过去二十年中,适用于复杂主动脉病变血管内治疗的技术和创新发展迅速。尽管血管内主动脉修复的初期效果极佳,但随着长期数据的出现,包括内漏、移植物移位和移植物感染在内的并发症已变得明显且令人担忧。以前,血管内治疗的适应症仅限于降主动脉瘤和腹主动脉瘤。然而,随着技术和器械的改进,其适应症已有所扩大,目前,使用现成的器械治疗肾旁主动脉瘤和克劳福德4型胸腹主动脉瘤(TAAA)已成为可能。此外,定制器械可用于治疗主动脉弓或更广泛的胸腹主动脉瘤。血管内治疗不仅适用于动脉瘤,也适用于急性/慢性夹层。然而,长期疗效仍不明确。本文概述了可用的器械以及各种主动脉病变的血管内治疗结果。