Department of Surgery, Rutgers University - New Jersey Medical School, Newark, NJ.
Heart and Vascular Hospital, Hackensack University Medical Center, Hackensack, NJ.
J Vasc Surg. 2020 Nov;72(5):1544-1551. doi: 10.1016/j.jvs.2020.02.022. Epub 2020 Apr 8.
The Global Registry for Endovascular Aortic Treatment is a prospective observational multicenter cohort registry of all Gore aortic endografts for a variety of aortic pathologies. The purpose of this study was to evaluate the outcome of the Conformable GORE TAG Thoracic Endoprosthesis and GORE TAG Thoracic Endoprosthesis devices for ruptured thoracic aortic syndromes.
Between December 2010 and October 2016, a total of 5018 patients were enrolled from 114 international sites in this registry. The database was queried for patients with at least one of the following pathologies: descending thoracic aortic aneurysm with rupture, thoracoabdominal aortic aneurysm rupture, descending aortic dissection rupture, and aortic arch aneurysm rupture. Patient demographics, operative details, and clinical outcomes were analyzed.
A total of 40 patients were treated with a ruptured thoracic aortic disease (62.5% male; mean age, 67.5 ± 14.1 years). Nineteen patients were treated for descending thoracic aneurysm rupture, 9 for thoracoabdominal aneurysm rupture, 7 for descending aortic dissection rupture, and 5 for aortic arch aneurysm rupture. Technical success was achieved in 40 of 40 patients (100%). There were no intraoperative mortalities and no conversions to an open procedure. A total of 12 patients (30.0%) required intervention for involvement of at least one aortic branch vessel (4 covered, 5 surgically debranched, 1 stented, and 6 chimney technique). The 30-day mortality was four patients (10.0%). Early reintervention (≤30 days) was required in seven patients (17.5%), five of which were device related. There was a total of five endoleaks and all five required a reintervention. The median follow-up duration was 14.7 months (range, 1-57 months). Freedom from device-related intervention at 1 year was 87.1% (95% confidence interval, [CI], 0.716-0.944), at 2 years was 81.3% (95% CI 0.607-0.917) and at 3 years was 73.1% (95% CI, 0.47-0.878). Freedom from all-cause mortality at 1 year was 65.0% (95% CI, 0.474-0.780), at 2 years was 61.2% (95% CI, 0.431-0.751), and at 3 years was 56.1% (95% CI, 0.369-0.715).
The Conformable GORE TAG Thoracic Endoprosthesis and GORE TAG Thoracic Endoprosthesis thoracic endografts provide an effective treatment for ruptured thoracic aortic diseases. Adjunctive coverage or revascularization of an aortic branch vessel may be necessary. Longer follow-up and larger studies are needed to determine durability of these repairs.
全球血管内主动脉治疗登记处是一个针对各种主动脉病变的戈尔主动脉内支架的前瞻性观察性多中心队列登记处。本研究的目的是评估适形戈尔 TAG 胸主动脉支架和戈尔 TAG 胸主动脉支架在破裂性胸主动脉综合征中的应用效果。
2010 年 12 月至 2016 年 10 月，该登记处共纳入来自 114 个国际站点的 5018 例患者。对数据库进行查询，以确定至少有以下一种病变的患者：降主动脉夹层动脉瘤破裂、胸腹主动脉瘤破裂、降主动脉夹层破裂和主动脉弓动脉瘤破裂。分析患者的人口统计学、手术细节和临床结果。
共有 40 例患者接受破裂性胸主动脉疾病治疗（62.5%为男性；平均年龄 67.5±14.1 岁）。19 例患者接受降主动脉夹层动脉瘤破裂治疗，9 例患者接受胸腹主动脉瘤破裂治疗，7 例患者接受降主动脉夹层破裂治疗，5 例患者接受主动脉弓动脉瘤破裂治疗。40 例患者（100%）达到技术成功。无术中死亡，无转为开放手术。共有 12 例（30.0%）患者至少有一个主动脉分支血管受累需要干预（4 例覆盖，5 例手术去分支，1 例支架植入，6 例烟囱技术）。30 天死亡率为 4 例（10.0%）。7 例（17.5%）患者需要早期（≤30 天）再次干预，其中 5 例与器械相关。共有 5 例内漏，所有 5 例均需要再次干预。中位随访时间为 14.7 个月（范围，1-57 个月）。1 年时器械相关干预的无复发率为 87.1%（95%置信区间，[CI]，0.716-0.944），2 年时为 81.3%（95% CI，0.607-0.917），3 年时为 73.1%（95% CI，0.47-0.878）。1 年时全因死亡率的无复发率为 65.0%（95% CI，0.474-0.780），2 年时为 61.2%（95% CI，0.431-0.751），3 年时为 56.1%（95% CI，0.369-0.715）。
适形戈尔 TAG 胸主动脉支架和戈尔 TAG 胸主动脉支架为破裂性胸主动脉疾病提供了有效的治疗方法。可能需要覆盖或重建主动脉分支血管。需要更长时间的随访和更大的研究来确定这些修复的耐久性。
