胸主动脉腹主动脉瘤的腔内修复：采用开窗和分支型腔内移植物。
Endovascular repair of thoraco-abdominal aortic aneurysms by fenestrated and branched endografts†.
机构信息
Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
出版信息
Eur J Cardiothorac Surg. 2019 Nov 1;56(5):993-1000. doi: 10.1093/ejcts/ezz125.
OBJECTIVES
Our objective was to report the outcomes of fenestrated/branched endovascular aneurysm repair of thoraco-abdominal aortic aneurysms (TAAAs) with endografts.
METHODS
Between January 2010 and April 2018, patients with TAAAs, considered at high surgical risk for open surgery and treated by Cook-Zenith fenestrated/branched endovascular aneurysm repair, were prospectively enrolled and retrospectively analysed. The early end points were 30-day/hospital mortality rate, spinal cord ischaemia and 30-day cardiopulmonary and nephrological morbidity. Follow-up end points were survival, patency of target visceral vessels and freedom from reinterventions.
RESULTS
Eighty-eight patients (male: 77%; mean age: 73 ± 7 years; American Society of Anesthesiologists 3/4: 58/42%) were enrolled. Using Crawford's classification, 43 (49%) were types I-III and 45 (51%) were type IV TAAAs. The mean aneurysm diameter was 65 ± 15 mm. Custom-made and off-the-shelf endografts were used in 60 (68%) and 28 (32%) cases, respectively. Five (6%) patients had a contained ruptured TAAA. The procedure was performed in multiple steps in 42 (48%) cases. There was 1 (1%) intraoperative death. Five (6%) patients suffered spinal cord ischaemia with permanent paraplegia in 3 (3%) cases. Postoperative cardiac and pulmonary complications occurred in 7 (8%) and 12 (14%) patients, respectively. Worsening of renal function (≥30% of baseline level) was detected in 11 (13%) cases, and 2 (2%) patients required haemodialysis. The 30-day and hospital mortality rates were 5% and 8%, respectively. The mean follow-up was 36 ± 22 months. Survival at 12, 24 and 36 months was 89%, 75% and 70%, respectively. The patency of target visceral vessels at 12, 24 and 36 months was 92%, 92% and 92%, respectively. Freedom from reinterventions at 12, 24 and 36 months was 85%, 85% and 83%, respectively.
CONCLUSIONS
The endovascular repair of TAAAs with fenestrated/branched endovascular aneurysm repair is feasible and effective with acceptable technical/clinical outcomes at early/midterm follow-up.
目的
本研究旨在报告使用 Cook-Zenith 分支型/开窗型血管腔内移植物治疗胸主动脉腹主动脉瘤（TAAA）的结果。
方法
2010 年 1 月至 2018 年 4 月，连续前瞻性纳入了因手术风险高而不适合开放手术治疗的 TAAA 患者，并对其进行回顾性分析。主要早期终点包括 30 天/院内死亡率、脊髓缺血及 30 天心肺和肾脏并发症发生率。随访终点为生存率、靶内脏血管通畅率和免于再次干预率。
结果
共纳入 88 例患者（男性占 77%；平均年龄 73±7 岁；美国麻醉医师协会 3/4 级：58/42%）。根据 Crawford 分类，43 例（49%）为Ⅰ-Ⅲ型，45 例（51%）为Ⅳ型 TAAA。平均瘤径为 65±15mm。60 例（68%）采用定制型移植物，28 例（32%）采用非定制型移植物。5 例（6%）患者为 TAAA 破裂伴包裹性血肿。42 例（48%）患者进行了多步手术。术中死亡 1 例（1%）。5 例（6%）患者发生脊髓缺血，3 例（3%）发生永久性截瘫。术后发生心脏并发症 7 例（8%），肺部并发症 12 例（14%）。11 例（13%）患者发生肾功能恶化（基线水平增加≥30%），2 例（2%）需要血液透析。30 天及院内死亡率分别为 5%和 8%。平均随访 36±22 个月。12、24 和 36 个月生存率分别为 89%、75%和 70%。12、24 和 36 个月靶内脏血管通畅率分别为 92%、92%和 92%。12、24 和 36 个月免于再次干预率分别为 85%、85%和 83%。
结论
在中短期随访中，分支型/开窗型血管腔内移植物治疗 TAAA 是可行且有效的，技术和临床结果可接受。
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