使用现成的分支型覆膜支架进行紧急胸主动脉腹主动脉瘤腔内修复术。
Urgent endovascular repair of thoracoabdominal aneurysms using an off-the-shelf multibranched endograft.
机构信息
Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, IRCCS Sant'Orsola-Malpighi, 9th Massarenti Street, 40100, Bologna, Italy.
出版信息
Eur J Cardiothorac Surg. 2022 May 2;61(5):1087-1096. doi: 10.1093/ejcts/ezab553.
OBJECTIVES
Our goal was to report outcomes of the endovascular repair of urgent thoracoabdominal aortic aneurysms (TAAAs) using the Cook Zenith t-Branch off-the-shelf multibranched endograft.
METHODS
Between 2010 and 2020, we collected patients with TAAAs who received an urgent endovascular repair using the Cook Zenith t-Branch (had a rupture, symptoms or diameter >80 mm). Thirty-day mortality, spinal cord ischaemia (SCI) and clinical success were assessed as early outcomes. Freedom from reintervention, target visceral vessel patency and survival were considered during follow-up.
RESULTS
Sixty-five cases were managed using the Cook Zenith t-Branch for 27 (42%) TAAA ruptures, 8 (12%) symptomatic TAAAs and 30 (46%) asymptomatic TAAAs with a diameter >80 mm. Crawford's extent I-II-III and IV were noted in 54 (83%) and 11 (17%), respectively. Eleven (17%) patients had SCI with 3 (5%) cases of permanent paraplegia. Postoperative dialysis (P = 0.04) and ruptured TAAAs (P = 0.05) were associated with SCI. Sixteen (25%) patients had reinterventions within the first 30 days postoperatively. The 30-day mortality was 14% (9). Ruptured TAAAs (P = 0.05) and technical failures (P = 0.01) were correlated with in-hospital mortality. Clinical success was 78% (51 patients). The mean follow-up was 18 ± 14 months. Survival at 24 months was 47% with no late TAAA-related deaths. Patients with ruptured TAAAs had lower survival than those who did not have ruptured TAAAs (52% vs 60% at 1 year; P = 0.05). Target visceral vessel patency and freedom from reintervention at 24 months were 89% and 60%, respectively.
CONCLUSIONS
An off-the-shelf multibranched endograft is safe and effective for treating urgent TAAAs. Postoperative SCI and 30-day mortality are satisfactory for this challenging clinical scenario. The early reintervention rate is not negligible. Midterm survival is low, especially in patients with a ruptured TAAA; therefore, accurate patient selection is mandatory.
目的
本研究旨在报告使用库克 Zenith t-Branch 分支型覆膜支架治疗紧急胸腹主动脉瘤（TAAA）的结果。
方法
2010 年至 2020 年，我们收集了使用库克 Zenith t-Branch 分支型覆膜支架治疗的 TAAA 患者的临床资料，这些患者接受了紧急血管内修复治疗（破裂、症状或直径>80mm）。30 天死亡率、脊髓缺血（SCI）和临床成功率被评估为早期结果。在随访期间评估免于再次干预、目标内脏血管通畅率和生存率。
结果
65 例患者使用库克 Zenith t-Branch 分支型覆膜支架治疗，其中 27 例（42%）为 TAAA 破裂，8 例（12%）为症状性 TAAA，30 例（46%）为无症状 TAAA，直径>80mm。Crawford Ⅰ-Ⅱ-Ⅲ和Ⅳ型分别为 54 例（83%）和 11 例（17%）。11 例（17%）患者发生 SCI，其中 3 例（5%）为永久性截瘫。术后透析（P=0.04）和 TAAA 破裂（P=0.05）与 SCI 相关。16 例（25%）患者在术后 30 天内再次干预。30 天死亡率为 14%（9 例）。TAAA 破裂（P=0.05）和技术失败（P=0.01）与住院期间死亡率相关。临床成功率为 78%（51 例）。平均随访时间为 18±14 个月。24 个月的生存率为 47%，无晚期 TAAA 相关死亡。TAAA 破裂患者的生存率低于未破裂 TAAA 患者（1 年时为 52% vs 60%；P=0.05）。24 个月时目标内脏血管通畅率和免于再次干预率分别为 89%和 60%。
结论
使用现成的分支型覆膜支架治疗紧急 TAAA 是安全有效的。对于这种具有挑战性的临床情况，术后 SCI 和 30 天死亡率是令人满意的。早期再干预率不容忽视。中期生存率较低，尤其是 TAAA 破裂患者；因此，必须进行准确的患者选择。
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