Sultan Sherif, Acharya Yogesh, Chua Vi Long Keegan, Hatem Mohamed, Hezima Mohieldin, Veerasingham David, Soliman Osama, Hynes Niamh
Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, University of Galway, Galway, Ireland.
Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland and University of Galway, Galway Affiliated Hospital, Doughiska, Ireland.
Front Surg. 2023 Mar 28;10:1157457. doi: 10.3389/fsurg.2023.1157457. eCollection 2023.
Thoracoabdominal acute aortic syndrome is associated with high morbidity and mortality. We aim to scrutinize our evolving strategies for acute aortic syndrome (AAS) management using minimally invasive and adaptive surgical techniques over two decades.
This is a longitudinal observational study at our tertiary vascular centre from 2002 to 2021. Out of 22,349 aortic referrals, we performed 1,555 aortic interventions over twenty years. Amongst 96 presented with symptomatic aortic thoracic pathology, 71 patients had AAS. Our primary endpoint is combined aneurysm-related and cardiovascular-related mortality.
There were 43 males and 28 females (5 Traumatic Aortic Transection (TAT), 8 Acute Aortic Intramural Hematoma (IMH), 27 Symptomatic Aortic Dissection (SAD) and 31 Thoracic Aortic Aneurysm (TAA) post-SAD) with a mean age of 69. All the patients with AAS received optimal medical therapy (OMT), but TAT patients underwent emergency thoracic endovascular aortic repair (TEVAR). Fifty-eight patients had an aortic dissection, of which 31 developed TAA. These 31 patients with SAD and TAA received OMT initially and interval surgical intervention with TEVAR or sTaged hybrId sinGle lumEn Reconstruction (TIGER). To increase our landing area, we performed a left subclavian chimney graft with TEVAR in twelve patients. The average follow-up duration was 78.2 months, and eleven patients (15.5%) had combined aneurysm and cardiovascular-related mortality. Twenty-six percentage of the patients developed endoleaks (EL), of which 15% required re-intervention for type II and III. Four patients who had paraplegia (5.7%) and developed renal failure died. None of our patients had a stroke or bowel ischaemia. Twenty patients had OMT, eight of these were patients with acute aortic hematoma, and all eight died within 30 days of presentation.
Acute aortic hematoma is a sinister finding, which must be closely monitored, and consideration is given to early intervention. Paraplegia and renal failure result in an increased mortality rate. TIGER technique with interval TEVAR has salvaged complex situations in young patients. Left subclavian chimney increases our landing area and abolishes SINE. Our experience shows that minimally invasive techniques could be a viable option for AAS.
胸腹主动脉急性综合征与高发病率和死亡率相关。我们旨在审视过去二十年来我们使用微创和适应性手术技术管理急性主动脉综合征（AAS）的不断演变的策略。
这是一项在我们的三级血管中心进行的从2002年至2021年的纵向观察性研究。在22349例主动脉转诊病例中，我们在二十年内进行了1555例主动脉干预。在96例出现有症状的胸主动脉病变的患者中，71例患有AAS。我们的主要终点是与动脉瘤相关和与心血管相关的联合死亡率。
有43例男性和28例女性（5例创伤性主动脉横断（TAT），8例急性主动脉壁内血肿（IMH），27例有症状的主动脉夹层（SAD）和31例SAD后胸主动脉瘤（TAA）），平均年龄为69岁。所有AAS患者均接受了最佳药物治疗（OMT），但TAT患者接受了急诊胸主动脉腔内修复术（TEVAR）。58例患者患有主动脉夹层，其中31例发展为TAA。这31例SAD和TAA患者最初接受了OMT，并接受了TEVAR或分期杂交单腔重建术（TIGER）的间隔期手术干预。为了增加我们的锚定区，我们对12例患者进行了带TEVAR的左锁骨下烟囱式移植物植入术。平均随访时间为78.2个月，11例患者（15.5%）出现了与动脉瘤和心血管相关的联合死亡率。26%的患者发生了内漏（EL），其中15%的II型和III型内漏患者需要再次干预。4例发生截瘫（5.7%）并出现肾衰竭的患者死亡。我们的患者均未发生中风或肠缺血。20例患者接受了OMT，其中8例为急性主动脉血肿患者，所有8例均在就诊后30天内死亡。
急性主动脉血肿是一个不祥的发现，必须密切监测，并考虑早期干预。截瘫和肾衰竭导致死亡率增加。间隔期TEVAR的TIGER技术挽救了年轻患者的复杂病情。左锁骨下烟囱式移植物增加了我们的锚定区并消除了SINE。我们的经验表明，微创技术可能是AAS的一个可行选择。
