Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany; Department of Vascular Surgery, University Medical Centre Regensburg, Regensburg, Germany.
Department of Vascular Surgery, University Medical Centre Regensburg, Regensburg, Germany.
Eur J Vasc Endovasc Surg. 2019 Jan;57(1):102-109. doi: 10.1016/j.ejvs.2018.07.032. Epub 2018 Sep 1.
Patients surviving acute aortic dissection are at risk of developing a post-dissection thoraco-abdominal aortic aneurysm (PD-TAAA) during follow up, regardless of the type of treatment in the acute setting. Fenestrated and branched stent grafting (F/B-TEVAR) has been used with success to treat PD-TAAA, albeit reported only with short-term results. The aim of this study was to report mid-term results in a cohort of 71 patients.
This was a retrospective analysis of a prospectively maintained database including all patients with PD-TAAAs who underwent F/B-TEVAR within the period January 2010 - April 2017 at two vascular institutions experienced in endovascular techniques.
A total of 71 consecutive patients (56 male, mean age 63.8 ± 10.6 years) were treated. Technical success was achieved in 68/71 (95.8%) patients. In hospital mortality was four (5.6%) patients. Peri-operative morbidity was 19.6%. Three (4.2%) patients developed severe spinal cord ischaemia, one of these patients 12 months post-operatively. Mean follow up was 25.3 months (1-77 months). Cumulative survival rates at 12, 24, and 36 months were 84.7 ± 4.5%, 80.7 ± 5.1%, and 70.0 ± 6.7%, respectively. Estimated freedom from re-intervention at 12, 24, and 36 months was 80.7 ± 5.3%, 63.0 ± 6.9%, and 52.6 ± 8.0%, respectively. The main reasons for re-intervention were endoleak from visceral/renal arteries and iliac endoleak requiring extension. Target vessel occlusion occurred in 8/261 (3.1%) vessels (renal artery n = 4; superior mesenteric artery n = 2; coeliac artery n = 2). Mean aneurysm sac regression during follow up was 9.2 ± 8.8 mm, with a false lumen thrombosis rate of 85.4% for patients with a follow up longer than 12 months. No ruptures occurred during follow up.
F/B-TEVAR for post-dissection TAAA is feasible and associated with low peri-operative mortality and peri-operative morbidity. Mid-term results demonstrate a high rate of aneurysm sac regression. Rigorous follow up is required because of the significant re-intervention rate. Longer bridging covered stents for target vessels are advised.
无论急性发病时采用何种治疗方法，急性主动脉夹层存活的患者在随访期间都有发生夹层后胸腹主动脉瘤（PD-TAAA）的风险。对 PD-TAAA 进行开窗和分支支架移植术（F/B-TEVAR）的治疗已取得成功，尽管目前仅有短期结果的报道。本研究的目的是报告在两个血管治疗中心接受 F/B-TEVAR 治疗的 71 例患者的中期结果。
这是一项回顾性分析，纳入了 2010 年 1 月至 2017 年 4 月期间所有在两个有经验的血管内治疗中心接受 F/B-TEVAR 治疗的 PD-TAAA 患者。
共纳入 71 例连续患者（56 例男性，平均年龄 63.8±10.6 岁）。68/71（95.8%）例患者达到技术成功。院内死亡率为 4 例（5.6%）。围手术期并发症发生率为 19.6%。3 例（4.2%）患者发生严重脊髓缺血，其中 1 例发生在术后 12 个月。平均随访时间为 25.3 个月（1-77 个月）。12、24 和 36 个月时的累积生存率分别为 84.7±4.5%、80.7±5.1%和 70.0±6.7%。12、24 和 36 个月时免于再次干预的估计率分别为 80.7±5.3%、63.0±6.9%和 52.6±8.0%。再次干预的主要原因是内脏/肾动脉和髂内漏需要扩展的内漏。在 261 个血管中（肾动脉 n=4；肠系膜上动脉 n=2；腹腔干动脉 n=2）发生了 8 例（3.1%）靶血管闭塞。在随访期间，动脉瘤囊平均缩小 9.2±8.8mm，随访 12 个月以上的患者假腔血栓形成率为 85.4%。随访期间未发生破裂。
F/B-TEVAR 治疗 PD-TAAA 是可行的，其围手术期死亡率和围手术期发病率均较低。中期结果显示动脉瘤囊缩小率较高。由于再干预率较高，需要严格的随访。建议对靶血管使用更长的桥接覆盖支架。
