Kawaguchi S, Ishimaru S, Shimazaki T, Yokoi Y, Koizumi N, Obitsu Y, Ishikawa M
Second Department of Surgery, Tokyo Medical College, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Oct;46(10):971-5. doi: 10.1007/BF03217857.
Between February 1995 and December 1997, 50 cases (55 lesions) of thoracic aortic aneurysms including 20 cases of aortic dissections were treated with an endovascular technique using the stent grafts. All patients were treated in the operating room under general anesthesia and the stent grafts were implanted through 18 Fr. or 20 Fr. sheaths via femoral arteries under fluoroscopic guidance. The stent graft was composed of several units of self-expanding stainless-steel Z stents covered with an ultra-thin polyester fabric. Stent graft deployment was technically successful in 53 of 55 lesions (delivery success rate: 96.4%). Exclusion of the aneurysms and entry closing without endoleak were achieved within two weeks after the operation in 43 of 53 lesions (initial success rate: 81.1%). Endoleak was found in 10 lesions (minor endoleak: 8 and major endoleak: 2 lesions). Two patients died in the periopertive period of delivery failures as injury to external iliac artery and damage to the delivery sheath caused by tortuous and narrow access routes. Endovascular stent graft repair of thoracic aortic aneurysms is minimally invasive operation in comparison with conventional surgical graft replacement with extracorporeal circulation. These early results suggest that the stent graft repair is possibly safe and useful treatment for the patients of thoracic aortic aneurysms especially in high risk patients. However, careful long-term follow-up is necessary to prove the value and the effects of this endovascular treatment and improvement of the stent graft system and technical training of endovascular surgery for operators are required to reduce the delivery failure and to determine the stent graft repair is reliable treatment.
1995年2月至1997年12月期间，采用血管内技术使用支架型人工血管治疗了50例（55处病变）胸主动脉瘤，其中包括20例主动脉夹层。所有患者均在全身麻醉下于手术室接受治疗，支架型人工血管通过18F或20F鞘经股动脉在透视引导下植入。支架型人工血管由多个自膨式不锈钢Z形支架单元组成，表面覆盖超薄聚酯织物。55处病变中有53处支架型人工血管植入技术成功（输送成功率：96.4%）。53处病变中有43处在术后两周内实现了动脉瘤隔绝和入口封闭且无内漏（初始成功率：81.1%）。10处病变发现有内漏（小内漏：8处，大内漏：2处）。2例患者在输送失败的围手术期死亡，原因是迂曲狭窄的入路导致髂外动脉损伤和输送鞘损坏。与传统体外循环手术置换人工血管相比，胸主动脉瘤的血管内支架型人工血管修复术是微创手术。这些早期结果表明，支架型人工血管修复术对于胸主动脉瘤患者尤其是高危患者可能是安全有效的治疗方法。然而，需要进行仔细的长期随访以证明这种血管内治疗的价值和效果，并且需要改进支架型人工血管系统以及对血管内手术操作者进行技术培训，以减少输送失败并确定支架型人工血管修复术是可靠的治疗方法。
