Minimally Invasive Endovascular Repair of Ascending Thoracic Aortic Aneurysm with Use of Local Anesthesia and Conscious Sedation
Minimally Invasive Endovascular Repair of Ascending Thoracic Aortic Aneurysm with Use of Local Anesthesia and Conscious Sedation
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DOI：
10.14503/thij-17-6558
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发表时间：
2019-04-01
影响因子：
0.9
通讯作者：
Krajcer, Zvonimir
中科院分区：
文献类型：
--
作者：
Almanfi, Abdelkader;Krajcer, Zvonimir
升胸主动脉瘤(Ataa)通常采用手术治疗。目前还没有专门为Ataa血管内修复设计的商用装置，目前，多重解剖学和技术挑战影响了其可行性。我们描述了一种新的微创血管内修复Ataa的方法，包括局部麻醉、清醒镇静和24小时住院。连续两名合并合并症的男性患者(年龄分别为79岁和54岁)接受了经皮股动脉血管内成形术，使用商业上可获得的内移植物。患者1有囊状动脉瘤，患者2因近期手术修复Ataa而出现假性动脉瘤。这些患者在技术上成功、不复杂的手术后24小时出院。2个月后，计算机断层扫描显示无内漏或支架-移植物移位。我们的经验表明，对于选择的高危患者，微创血管内修复Ataa是可行的。我们描述了与此方法相关的程序、访问和关闭设备以及挑战。
Ascending thoracic aortic aneurysm (ATAA) is typically treated surgically. No commercially available device has been specifically designed for endovascular ATAA repair, and currently, multiple anatomic and technical challenges affect its feasibility. Previously, such repairs have been performed with the patients under general anesthesia.We describe a novel, minimally invasive approach to endovascular repair of ATAA, involving local anesthesia, conscious sedation, and 24-hour hospitalization. Two consecutive male patients (ages, 79 and 54 yr) who had comorbidities underwent percutaneous transfemoral endovascular ATAA repair with use of commercially available endografts. Patient 1 had a saccular aneurysm, and Patient 2 had a pseudoaneurysm consequent to recent surgical ATAA repair. The patients were discharged from the hospital 24 hours after technically successful, uncomplicated procedures. At 2 months, computed tomograms showed no endoleak or stent-graft migration. Our experience shows that minimally invasive endovascular ATAA repair is feasible for selected high-risk patients. We describe the procedure, access and closure devices, and challenges associated with this approach.