Thoracic endovascular stent graft repair for ascending aortic diseases
Thoracic endovascular stent graft repair for ascending aortic diseases
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DOI：
10.1016/j.jvs.2019.01.075
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发表时间：
2019-11-01
影响因子：
4.3
通讯作者：
Trimarchi, Santi
中科院分区：
文献类型：
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作者：
Piffaretti, Gabriele;Grassi, Viviana;Trimarchi, Santi
目的：我们描述了胸主动脉腔内修复术（TEVAR）的初步结果，在一组患者的升主动脉疾病的血管内治疗（GREAT）的全球注册表：方法：我们确定了TEVAR进行的疾病真正起源于升主动脉。2011年7月至2015年5月期间，入组了5014例患者;确定了6例（0.12%）患者并纳入分析。另有1例患者因未签署知情同意书而退出研究。未纳入TEVAR报告的近端锚定区为“0区”且不存在升主动脉疾病的患者。既往开放性和腔内修复术的再次干预也被排除在外。平均年龄为69岁+/- 10岁（范围，58-83岁）。TEVAR的适应症为动脉粥样硬化性动脉瘤（n = 4;破裂，n = 1）、复杂A型夹层（n = 1，破裂）和假性动脉瘤（n = 1）。平均最大主动脉病变直径为60 mm 14（范围，39-77 mm）。在3例（50%）病例中进行了紧急干预。初步临床成功率为100%。无TEVAR相关的院内死亡。从来不需要公开皈依。未发生脑血管意外、瓣膜损伤或心肌梗死等并发症。所有患者均存活出院回家。在中位随访26个月（范围，16-72个月）时，无患者失访。随访期间，无患者死亡，所有患者均保持了持续的主要临床成功。从未需要再次干预;结论：上行TEVAR的初步“真实世界”经验显示短期随访结果令人满意。尽管标准器械的“标签外”使用仍然存在问题，但未观察到TEVAR相关并发症。预计更长时间的随访数据将证实这些结果的持久性。
Objectives: We describe the preliminary results of thoracic endovascular aortic repair (TEVAR) in a group of patients with ascending aortic disease from the Global Registry for Endovascular Aortic Treatment (GREAT).Methods: We identified TEVAR performed for diseases truly originating from the ascending aorta. Between July 2011 and May 2015, 5014 patients were enrolled; six (0.12%) were identified and included in the analysis. One further patient was withdrawn from the study due to lack of a signed consent form. Patients having a "zone 0" proximal landing zone reported for their TEVAR without the presence of an ascending aortic disease were not included. Reinterventions of previous open and endovascular repair were also excluded.Results: Three males and three females were treated. Mean age was 69 years +/- 10 years (range, 58-83 years). Indication for TEVAR was atherosclerotic aneurysm (n = 4; ruptured, n = 1), complicated type A dissection (n = 1, rupture), and pseudoaneurysm (n = 1). Mean maximum aortic lesion diameter was 60 mm 14 (range, 39-77 mm). Urgent intervention was performed in three (50%) cases. Primary clinical success was 100%. There was no TEVAR-related in-hospital mortality. Open conversion was never required. Complication such as cerebrovascular accidents, valve impairment, or myocardial infarction did not occur. All patients were discharged home alive. No patient was lost at a median follow-up of 26 months (range, 16-72 months). During the follow-up, no patient died and ongoing primary clinical success was maintained in all patients. Reintervention was never required; endoleaks, migrations, fractures, or ruptures were not observed.Conclusions: Preliminary "real-world" experience of ascending TEVAR shows satisfactory outcomes at short-term follow-up. Although concerns remain for "off-label" use of standard devices, TEVAR-related complications were not observed. Longer follow-up data are expected to confirm durability of these results.