Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Ann Vasc Surg. 2022 Nov;87:446-460. doi: 10.1016/j.avsg.2022.05.023. Epub 2022 Jun 7.
Coarctation of the aorta with poststenotic aneurysms is rare and complex. Here we report a relatively large group of endovascular treatments for the disease.
Fifteen patients from two centers between 2006 and 2019 were included in the study. The patients were retrospectively divided into two groups. Patients in the complex group had insufficient proximal landing zone (<2 cm) or the zigzag shape of aorta. Their demographics, clinical manifestations, endovascular procedures, and follow-up results were analyzed.
There were 7 patients in the simple group and 8 patients in the complex group. Eleven patients were symptomatic. Despite the unfavorable anatomy in the complex group, technical success reached 100%. The diameter of coarctation increased from 8.6 mm to 16.7 mm with poststenotic aneurysms successfully excluded at the same time. In patients without sufficient proximal landing zone, left subclavian artery was covered by the stent grafts and then sacrificed (three patients) or revascularized (four patients). Other than one patient who suffered iliac artery rupture and received open repair, there was no other perioperative complications. Computed tomography angiography repeated at mean 42 months postoperation confirmed patency of stents and the exclusion of aneurysms with no aortic wall injury. Mild endoleaks occurred in two patients in the complex group and were left to observation. During 55.0 months follow-up, except for one patient who received secondary left subclavian artery fenestration, all other patients remained asymptomatic.
Endovascular treatments for coarctation of the aorta with poststenotic aneurysm showed a high technical success and could be an alternative solution for such disease.
主动脉缩窄合并术后动脉瘤较为罕见且复杂。本文报告了一组相对较大的此类疾病的血管内治疗病例。
2006 年至 2019 年间，两个中心的 15 名患者纳入本研究。患者被回顾性分为两组。复杂组患者的近端锚定区不足（<2cm）或主动脉呈 Zigzag 形。分析了他们的人口统计学、临床表现、血管内手术和随访结果。
简单组 7 例，复杂组 8 例。11 例患者有症状。尽管复杂组的解剖结构不理想，但技术成功率达到 100%。缩窄段直径从 8.6mm 增加到 16.7mm，同时成功排除了术后动脉瘤。在近端锚定区不足的患者中，左锁骨下动脉被支架移植物覆盖，随后被牺牲（3 例）或再血管化（4 例）。除 1 例髂动脉破裂接受开放修复外，无其他围手术期并发症。术后平均 42 个月的 CT 血管造影证实支架通畅，动脉瘤排除且无主动脉壁损伤。复杂组中有 2 例患者发生轻度内漏，予观察。55.0 个月随访期间，除 1 例患者接受二次左锁骨下动脉开窗术外，所有其他患者均无症状。
主动脉缩窄合并术后动脉瘤的血管内治疗具有较高的技术成功率，可为该病提供一种替代治疗方案。
