Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm.
Staged total abdominal debranching and thoracic endovascular aortic repair for thoracoabdominal aneurysm.
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DOI：
10.1016/j.jvs.2011.11.149
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发表时间：
2012-09
影响因子：
4.3
通讯作者：
McCann, Richard L.
中科院分区：
文献类型：
--
作者：
Hughes, G. Chad;Barfield, Michael E.;Shah, Asad A.;Williams, Judson B.;Kuchibhatla, Maragatha;Hanna, Jennifer M.;Andersen, Nicholas D.;McCann, Richard L.
胸腹主动脉瘤（TAAA）最常发生在老年人中，由于存在显著的合并症，他们通常不是开放修复术的最佳候选人。混合选择的可用性，包括开放内脏去分支和动脉瘤腔内隔绝术，可能在这些传统修复术风险高的患者中具有优势。本报告详细介绍了我们在高风险患者中进行TAAA修复术的完全内脏去分支和动脉瘤腔内隔绝术的技术进展和结果。2005年3月至2011年6月期间，47例患者（51%女性）接受了所有内脏血管的解剖外脱支，随后在一家机构通过血管内方法进行动脉瘤隔绝术。平均有四条内脏血管被旁路。脱支手术最初通过部分右内侧内脏旋转入路进行，在前22例患者中将左肾留在后方，在后25例患者中通过直接前方入路进入内脏血管。在最初的33例患者中，在单次手术中进行了手术的脱支和血管内部分，在最近的14例患者中，在单次住院期间进行了分期手术。患者中位年龄为71.0 ± 9.8岁。所有患者均存在显著的合并症，被认为是常规修复的次优候选者：55%既往接受过主动脉手术，40%为美国麻醉医师协会（阿萨）4级，基线血清肌酐为1.5 ± 1.3 mg/dL。30天/住院期间死亡、卒中和永久性下肢轻瘫/瘫痪的发生率分别为8.5%、0%和4.3%，但在最近14例接受分期修复的患者中为0%。与接受同期修复术的患者相比，这些患者的联合手术时间显著缩短（314 vs 373分钟），术中红细胞输注量减少（350 vs 1400 mL），并且更有可能在手术室拔管（50% vs 12%）。在19.3 ± 18.5个月的中位随访期内，内脏移植物通畅率为97%;所有闭塞肢体均位于肾血管，临床上无症状。未发生I型或III型内漏或再次干预。Kaplan-Meier总生存率为70.7%，2年和57.9%，5年。通过完全内脏去分支和动脉瘤腔内隔绝术进行的混合TAAA修复术是不适合在具有内脏血运重建必要外科专业知识的中心进行传统修复术的老年高风险患者的良好选择。在单次住院期间进行分阶段去分支和动脉瘤腔内隔绝术似乎可获得最佳结果。
Thoracoabdominal aortic aneurysms (TAAAs) occur most commonly in elderly individuals, who are often suboptimal candidates for open repair because of significant comorbidities. The availability of a hybrid option, including open visceral debranching with endovascular aneurysm exclusion, may have advantages in these patients who are at high-risk for conventional repair. This report details the evolution of our technique and results with complete visceral debranching and endovascular aneurysm exclusion for TAAA repair in high-risk patients. Between March 2005 and June 2011, 47 patients (51% women) underwent extra-anatomic debranching of all visceral vessels, followed by aneurysm exclusion by endovascular means at a single institution. A median of four visceral vessels were bypassed. The debranching procedure was initially performed through a partial right medial visceral rotation approach, leaving the left kidney posterior in the first 22 patients, and in the last 25 by a direct anterior approach to the visceral vessels. The debranching and endovascular portions of the procedure were performed in a single operation in the initial 33 patients and as a staged procedure during a single hospital stay in the most recent 14. Median patient age was 71.0 ± 9.8 years. All had significant comorbidity and were considered suboptimal candidates for conventional repair: 55% had undergone previous aortic surgery, 40% were American Society of Anesthesiologists (ASA) class 4, and baseline serum creatinine was 1.5 ± 1.3 mg/dL. The 30-day/in-hospital rates of death, stroke, and permanent paraparesis/plegia were 8.5%, 0%, and 4.3%, respectively, but 0% in the most recent 14 patients undergoing staged repair. These patients had significantly shorter combined operative times (314 vs 373 minutes), decreased intraoperative red blood cell transfusions (350 vs 1400 mL), and were more likely to be extubated in the operating room (50% vs 12%) compared with patients undergoing simultaneous repair. Over a median follow-up of 19.3 ± 18.5 months, visceral graft patency was 97%; all occluded limbs were to renal vessels and clinically silent. There have been no type I or III endoleaks or reinterventions. Kaplan-Meier overall survival is 70.7% at 2 years and 57.9% at 5 years. Hybrid TAAA repair through complete visceral debranching and endovascular aneurysm exclusion is a good option for elderly high-risk patients less suited to conventional repair in centers with the requisite surgical expertise with visceral revascularization. A staged approach to debranching and endovascular aneurysm exclusion during a single hospitalization appears to yield optimal results.
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影响因子：
4.3
作者：
Chaikof, EL;Blankensteijn, JD;Kent, KC
通讯作者：
Kent, KC
DOI：
10.1016/j.ejvs.2009.03.018
发表时间：
2009-07-01
影响因子：
5.7
作者：
Chiesa, R.;Tshomba, Y.;Logaldo, D.
通讯作者：
Logaldo, D.
影响因子：
0.7
作者：
Verhoeven, E.;Tielliu, I. F.;Renner, H.
通讯作者：
Renner, H.
DOI：
10.1016/j.jtcvs.2010.07.061
发表时间：
2010-12-01
影响因子：
6
作者：
Greenberg, Roy;Eagleton, Matthew;Mastracci, Tara
通讯作者：
Mastracci, Tara
DOI：
10.1053/j.semtcvs.2009.11.010
发表时间：
2009-12-01
影响因子：
2.5
作者：
Hughes, G. Chad;McCann, Richard L.
通讯作者：
McCann, Richard L.