May J, White G H, Yu W, Waugh R, Stephen M S, Chaufour X, Harris J P
Department of Surgery University of Sydney, New South Wales, Australia.
Cardiovasc Surg. 1998 Apr;6(2):194-7. doi: 10.1016/s0967-2109(97)00132-4.
The incidence and indications for conversion from endoluminal to open repair of abdominal aortic aneurysms are changing. This paper is based on a 5-year experience in which endoluminal repair of abdominal aortic aneurysms was undertaken in 156 patients. Primary conversion at the original operation was required in 14 patients and secondary conversion at a subsequent operation was required in 9 patients. The reasons for primary conversion were access problems (n = 2), balloon related problems (n = 2), endograft migration (n = 4), endograft thrombosis (n = 1) and failed deployment of a bifurcated endograft (n = 5). Twelve of 14 primary conversions occurred in the first half of the study period, in which 59 endoluminal abdominal aortic aneurysms repairs were undertaken. Improvements in technology and interventional techniques for overcoming obstacles, as well as increasing experience, has resulted in primary conversion being limited to two patients in the most recent 2.5-year period in which 97 endoluminal repairs were undertaken. The reasons for secondary conversion were renal arteries covered by the endograft (n = 2), increasing abdominal aortic aneurysm diameter in the absence of endoleak (n = 1) and persistent endoleak (n = 6). The latter group comprised three patients with intact aneurysms and three with known endoleaks who presented with ruptured aneurysms. The current indications for primary conversion include: (i) rupture of the aorta; (ii) complete migration of the endograft resulting in obstruction of the iliac arteries; and (iii) irreversible twisting of a non-modular bifurcated endograft. The current indications for secondary conversion include: (i) persistent endoleak; (ii) sealed endoleak with continued abdominal aortic aneurysms expansion; (iii) apparently successful endoluminal repair without evidence of endoleak but continued abdominal aortic aneurysms expansion; and (iv) infected endograft.
腹主动脉瘤腔内修复术转为开放修复术的发生率及指征正在发生变化。本文基于一项5年的经验，其中156例患者接受了腹主动脉瘤腔内修复术。14例患者在初次手术时需要进行一期转换，9例患者在后续手术时需要进行二期转换。一期转换的原因包括入路问题（n = 2）、球囊相关问题（n = 2）、移植物移位（n = 4）、移植物血栓形成（n = 1）以及分叉型移植物展开失败（n = 5）。14例一期转换中有12例发生在研究期的前半段，在此期间进行了59例腹主动脉瘤腔内修复术。技术和介入技术的改进以及经验的增加，使得在最近2.5年进行97例腔内修复术时，一期转换仅限于2例患者。二期转换的原因包括移植物覆盖肾动脉（n = 2）、在无内漏情况下腹主动脉瘤直径增大（n = 1）以及持续性内漏（n = 6）。后一组包括3例动脉瘤完整的患者和3例已知有内漏且动脉瘤破裂的患者。目前一期转换的指征包括：（i）主动脉破裂；（ii）移植物完全移位导致髂动脉阻塞；（iii）非模块化分叉型移植物不可逆扭转。目前二期转换的指征包括：（i）持续性内漏；（ii）内漏封闭但腹主动脉瘤持续扩张；（iii）腔内修复术看似成功且无内漏证据但腹主动脉瘤持续扩张；（iv）移植物感染。
