European Vascular Center Aachen-Maastricht, University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
J Vasc Surg. 2022 Mar;75(3):824-832. doi: 10.1016/j.jvs.2021.09.026. Epub 2021 Oct 1.
To describe the outcome of open thoracoabdominal aortic aneurysm (TAAA) repair following previous aortic arch repair including elephant trunk (ET) or frozen elephant trunk (FET) for acute and chronic pathologies.
This was a retrospective, observational, multicenter study including 32 patients treated between 2006 and 2019 in two aortic centers using identical surgical protocols. Assessment focused on perioperative and long-term outcome, namely in-hospital morbidity and mortality, as well as procedure-related reintervention rate and aortic-related mortality rate. Kaplan-Meier curves with 95% confidence intervals were used to analyze the overall survival after surgery within the cohort.
Thirty-two patients (mean age, 45.0 ± 13.6 years; 20 males [62.5%]) were treated because of acute (34.38% [n = 11]) or chronic (65.62% [n = 21]) aortic pathologies, including residual dissection following acute, symptomatic type A dissection (n = 7) and symptomatic mega aortic syndrome (n = 4), as well as post-dissection TAAA (n = 18) and asymptomatic mega aortic syndrome (n = 3). Twenty-eight patients (87.5%) received type II repair, and 4 patients (12.5%) received type III repair after previous ascending aorta and arch repair including ET/FET. Concomitant infrarenal and iliac vessel repair was performed in 38.7% (n = 12) and 29.4% (n = 10), respectively. The in-hospital mortality rate was 18.75% (n = 6). Spinal cord ischemia occurred in two cases, both after one-stage emergency procedure with one case of permanent paraplegia. Temporary acute kidney injury occurred in 41.94% (n = 13). The estimated 1-year survival rate was 78.1% (95% confidence interval, 63.9%-95.6%), with a median follow-up time of 1.29 years (interquartile range, 0.26-3.88 years). No procedure-related reinterventions and one case of aortic-related mortality, namely sepsis because of graft infection, was observed.
Open TAAA repair following aortic arch repair including ET or FET because of acute or chronic aortic pathologies is associated with a relevant perioperative morbidity and mortality rate. During follow-up, a low aortic-related mortality rate and procedure-related reintervention rate were observed.
描述既往行主动脉弓部修复（包括象鼻手术或冷冻象鼻手术）治疗急性和慢性病变后行开放胸腹主动脉瘤（TAAA）修复的结果。
这是一项回顾性、观察性、多中心研究，纳入 2006 年至 2019 年在两家主动脉中心接受治疗的 32 例患者，采用相同的手术方案。评估重点为围手术期和长期结果，即院内发病率和死亡率，以及与手术相关的再次干预率和主动脉相关死亡率。使用 Kaplan-Meier 曲线（95%置信区间）分析队列中手术后的总体生存率。
32 例患者（平均年龄 45.0±13.6 岁；男性 20 例[62.5%]）因急性（34.38%[n=11]）或慢性（65.62%[n=21]）主动脉病变而接受治疗，包括急性、有症状的 A 型夹层（n=7）和有症状的巨大主动脉综合征（n=4）的急性夹层后残留夹层，以及夹层后 TAAA（n=18）和无症状的巨大主动脉综合征（n=3）。28 例（87.5%）患者接受 II 型修复，4 例（12.5%）患者在既往升主动脉和弓部修复后（包括象鼻或冷冻象鼻手术）接受 III 型修复。同时行肾下腹主动脉和髂血管修复的患者分别占 38.7%（n=12）和 29.4%（n=10）。院内死亡率为 18.75%（n=6）。2 例发生脊髓缺血，均为一期急诊手术后，1 例发生永久性截瘫。41.94%（n=13）患者发生暂时性急性肾损伤。估计 1 年生存率为 78.1%（95%置信区间，63.9%-95.6%），中位随访时间为 1.29 年（四分位距，0.26-3.88 年）。未发生与手术相关的再次干预，1 例患者发生主动脉相关死亡，即因移植物感染导致的败血症。
既往行主动脉弓部修复（包括象鼻手术或冷冻象鼻手术）治疗急性或慢性主动脉病变后行开放 TAAA 修复，围手术期发病率和死亡率较高。在随访期间，主动脉相关死亡率和与手术相关的再次干预率较低。
