May J, White G H, Yu W, Waugh R, Stephen M, Sieunarine K, Harris J P
Department of Vascular Surgery, Royal Prince, Alfred Hospital, NWS, Australia.
Eur J Vasc Endovasc Surg. 1997 Jul;14(1):4-11. doi: 10.1016/s1078-5884(97)80218-3.
The purpose of this study was to analyse the technical problems associated with conversion from endoluminal repair of abdominal aortic aneurysms (AAA) to open repair and document the outcome in patients with this clinical course.
Between May 1992 and May 1996 endoluminal repair of AAA was undertaken in 113 patients. Forty-eight of these had medical co-morbidities which led to them being rejected for open repair at other medical centres. Conversion from endoluminal to open repair was required in 18 patients. Thirteen of these occurred at the original operation (primary conversion) and five occurred at a later operation (secondary conversion). Seven of the 18 patients undergoing conversion had serious medical co-morbidities. Three different methods of open repair were used. The technique selected was determined by the cause of failure leading to conversion. Standard open AAA repair was used in patients requiring conversion for access problems (n = 2) and balloon malfunction, where the device ended up entirely within the aneurysmal sac (n = 1). Modifications to the standard technique were required in patients in which the endograft was correctly positioned immediately below the renal arteries and/or where part of the endograft was within one or both common iliac arteries (n = 11). Supra-coeliac control was required for patients with aortic rupture (n = 1), renal arteries covered by the endograft (n = 2) and situations where the delivery catheter was trapped within the aorta above a twisted bifurcated graft (n = 1). The mean volume of contrast used was 225 ml and the mean operative time was 5.25 h in patients undergoing primary conversion.
Conversion to open repair was achieved in all 18 patients. Renal impairment requiring dialysis occurred in three patients. There were three perioperative deaths, all of which were procedure-related (17%), and one late death. All four deaths occurred from among the group of seven patients with preoperative co-morbidities.
Converting an endoluminal to an open AAA repair may require modifications to the standard open technique and result in a much higher than generally accepted morbidity and mortality rate. Patients rejected for open repair because of co-morbidities ran the same chance of requiring conversion as those without co-morbidities (15-17%). If conversion was required, however, they stood a 3 in 7 or 43% chance of dying.
本研究旨在分析腹主动脉瘤（AAA）腔内修复转为开放修复相关的技术问题，并记录有此临床过程患者的治疗结果。
1992年5月至1996年5月期间，对113例患者进行了AAA腔内修复。其中48例存在合并症，导致他们在其他医疗中心被拒绝进行开放修复。18例患者需要从腔内修复转为开放修复。其中13例发生在初次手术时（初次转换），5例发生在后期手术时（二次转换）。18例接受转换的患者中有7例存在严重合并症。采用了三种不同的开放修复方法。所选择的技术取决于导致转换的失败原因。对于因入路问题（n = 2）和球囊故障（装置完全位于动脉瘤腔内，n = 1）而需要转换的患者，采用标准的开放AAA修复。对于腔内移植物正确定位在肾动脉下方和/或部分腔内移植物位于一条或两条髂总动脉内的患者（n = 11），需要对标准技术进行修改。对于主动脉破裂患者（n = 1）、腔内移植物覆盖肾动脉患者（n = 2）以及输送导管被困在扭曲分叉移植物上方的主动脉内的情况（n = 1），需要进行腹腔干上方控制。初次转换患者使用造影剂的平均量为225 ml，平均手术时间为5.25小时。
18例患者均成功转为开放修复。3例患者出现需要透析的肾功能损害。围手术期死亡3例，均与手术相关（17%），1例为晚期死亡。4例死亡均发生在术前有合并症的7例患者中。
将AAA腔内修复转为开放修复可能需要对标准开放技术进行修改，并导致发病率和死亡率远高于普遍接受的水平。因合并症被拒绝进行开放修复的患者与无合并症患者需要转换的几率相同（15 - 17%）。然而，如果需要转换，他们有七分之三或43%的死亡几率。
