Tohme Scarlett, Newman Joshua, Yu Pey-Jen
Department of Cardiovascular and Thoracic Surgery, Northwell Health, Manhasset, New York.
Department of Cardiovascular and Thoracic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Int J Angiol. 2023 Jul 26;33(4):222-228. doi: 10.1055/s-0043-1771343. eCollection 2024 Dec.
Thoracoabdominal aortic aneurysms (TAAAs) are complex and if untreated have high mortality and morbidity rates. Open surgical repair is the historical treatment approach; however, postoperative complications remain high with spinal cord ischemia notably one of the more serious and common complications. The avoidance of thoracotomy or laparotomy with the advent of endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) have decreased the morbidity and mortality with TAAA repair, especially in patients with significant comorbidities such as a history of aortic surgery, underlying cardiac disease, and chronic obstructive pulmonary disease. Endovascular treatment options have grown to include fenestrated EVAR, multibranched EVAR, and physician-modified fenestration stent grafts. These techniques have achieved lower mortality rates than traditional open repair, but complications such as limb ischemia, spinal cord ischemia, and long-term durability must be considered. This review provides an overview of the most common endovascular techniques for TAAAs as well as short- and midterm outcomes.
胸腹主动脉瘤（TAAAs）情况复杂，若不治疗，死亡率和发病率很高。开放手术修复是过去的治疗方法；然而，术后并发症仍然很多，脊髓缺血是较为严重且常见的并发症之一。随着血管腔内主动脉修复术（EVAR）和胸主动脉腔内修复术（TEVAR）的出现，避免了开胸或开腹手术，降低了TAAA修复的发病率和死亡率，尤其是对于有主动脉手术史、潜在心脏病和慢性阻塞性肺疾病等严重合并症的患者。血管腔内治疗选择已发展到包括开窗式EVAR、多分支EVAR和医生改良开窗支架移植物。这些技术已实现了比传统开放修复更低的死亡率，但必须考虑肢体缺血、脊髓缺血和长期耐久性等并发症。本综述概述了TAAA最常见的血管腔内技术以及短期和中期结果。
