Stent-grafting of the thoracic aorta by the cardiothoracic surgeon.
Stent-grafting of the thoracic aorta by the cardiothoracic surgeon.
复制标题
由心胸外科医生对胸主动脉进行支架移植。
DOI：
10.1016/j.athoracsur.2006.09.036
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
R. Hetzer
中科院分区：
文献类型：
--
作者：
B. Zipfel;R. Hammerschmidt;T. Krabatsch;S. Buz;Y. Weng;R. Hetzer
方法172例胸主动脉内植入支架196枚。除1例手术外，所有手术均由心胸外科医生团队在手术室进行; 112例手术（57%）为急诊手术。24例手术（12%）为内漏再次手术。左锁骨下动脉起始部46例，左颈总动脉2例。174例手术通过股动脉切开入路，1例经皮股动脉入路，17例通过髂动脉或肾下主动脉导管入路。10例患者需手术重建受损的通路血管，术后30天死亡率为9.7%（19例患者）。截瘫发生率为1.0%（2例患者）。一次技术成功率为85.2%，二次技术成功率为91.8%。有6例需要转为开放性修复术，3例在手术期间，3例在出院前继发。精算生存率为79%，1年，67%，3年，55%，5 years.CONCLUSIONSThe结果是优秀的，考虑到高发病率的紧急程序和开放手术是没有前途的，在许多患者。心胸外科医生可以在接受血管内技术的充分培训后进行手术。由于可能需要扩大入路血管的手术入路或立即转为开放手术，因此必须掌握手术技能。因此，手术室是该手术的首选场所。
BACKGROUNDWe evaluated endovascular stent-grafting as a new technique in aortic surgery.METHODSOne hundred ninety-six stent-grafts were implanted in the thoracic aorta in 172 patients. All procedures but one were performed in the operating room by a team of cardiothoracic surgeons; 112 operations (57%) were emergency procedures. Twenty-four procedures (12%) were reoperations for endoleaks. The left subclavian artery origin was covered in 46 cases and the left common carotid artery in 2 cases. Access was by femoral cut-down in 174 procedures, percutaneous femoral approach in 1, and by conduit to the iliac arteries or infrarenal aorta in 17. Surgical reconstruction of damaged access vessels became necessary in 10 cases.RESULTSThirty-day mortality was 9.7% (19 patients). Paraplegia occurred in 1.0% (2 patients). Primary technical success was 85.2%, secondary 91.8%. Six conversions to open repair were necessary, 3 during the procedures and 3 secondarily before discharge. Actuarial survival was 79% at 1 year, 67% at 3 years, and 55% at 5 years.CONCLUSIONSThe results are excellent, taking into account the high incidence of emergency procedures and that open surgery is not promising in many patients. The cardiothoracic surgeon can perform the procedure after adequate training in endovascular techniques. Surgical skills are mandatory because of the potential need for extended surgical approach to the access vessels or immediate conversion to open surgery. Therefore, the operating room is the preferred site for this procedure.