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大动脉炎降主动脉手术经验:综述

Operative experience on descending aorta with Takayasu Arteritis: a review.

作者信息

Fu Yining, Chen Yuexin

机构信息

Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China.

出版信息

Front Cardiovasc Med. 2023 Jun 21;10:1181285. doi: 10.3389/fcvm.2023.1181285. eCollection 2023.

Abstract

Patients with Takayasu arteritis (TA) and descending aorta involvement often experience insidious onset and slow progression, leading to irreversible vascular lesions despite medication therapy. Surgical management plays a crucial role in resolving hemodynamic disturbances and has shown promise in improving the outcomes of this patient population, owing to significant advancements in surgical expertise. However, studies focusing on this rare disease are lacking. This review summarizes the characteristics of patients with stenosis in descending aorta, emphasizing surgical approaches, perioperative management, and disease outcomes. The operative approach depends on lesion location and extent. Existing studies have confirmed that the choice of surgical modality significantly influences postoperative complications and long-term prognosis in patients, highlighting the effectiveness of bypass surgery as a favorable option in clinical practice with a satisfactory long-term patency rate. To mitigate postoperative complications, it is advisable to conduct regular imaging follow-ups to prevent the deterioration of the condition. Notably, the occurrence of restenosis and pseudoaneurysm formation deserves particular attention due to their impact on patient survival. The use of perioperative medication remains a topic of debate, as previous studies have presented divergent perspectives. The primary objective of this review is to provide a comprehensive perspective on surgical treatment and offer customized surgical approaches for patients in this population.

摘要

患有大动脉炎(TA)且降主动脉受累的患者通常起病隐匿、进展缓慢,尽管接受药物治疗,仍会导致不可逆的血管病变。由于外科技术的显著进步,手术治疗在解决血流动力学紊乱方面发挥着关键作用,并已显示出改善该患者群体预后的前景。然而,针对这种罕见疾病的研究却很缺乏。本综述总结了降主动脉狭窄患者的特征,重点强调手术方法、围手术期管理和疾病转归。手术方式取决于病变的位置和范围。现有研究证实,手术方式的选择对患者术后并发症和长期预后有显著影响,突出了旁路手术作为临床实践中一种有利选择的有效性,其长期通畅率令人满意。为减轻术后并发症,建议定期进行影像学随访以防止病情恶化。值得注意的是,再狭窄和假性动脉瘤形成的发生因其对患者生存的影响而值得特别关注。围手术期药物的使用仍然是一个有争议的话题,因为先前的研究提出了不同的观点。本综述的主要目的是提供关于手术治疗的全面观点,并为该群体的患者提供定制的手术方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/acf6/10320220/b42f53c1baa7/fcvm-10-1181285-g001.jpg

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