Results of Endovascular Repair of TAAA in the First 50 Patients
Results of Endovascular Repair of TAAA in the First 50 Patients
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DOI：
10.1055/s-0031-1271550
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发表时间：
2011-10-01
影响因子：
0.7
通讯作者：
Renner, H.
中科院分区：
文献类型：
--
作者：
Verhoeven, E.;Tielliu, I. F.;Renner, H.
背景资料：开孔型和分支型覆膜支架的发展为治疗累及内脏动脉的复杂主动脉瘤开辟了道路。首次报道的胸腹动脉瘤的血管内治疗已经证明了technique.Methods的可行性：文献综述和结果的第一个50例患者治疗定制的Zenith设备与固定分支。大多数患者拒绝开放手术，主要是因为疾病的程度与合并症，其中包括在大多数患者的几个危险因素的组合。平均动脉瘤大小为71 mm，动脉瘤的程度为I型（n=9），II型（n=13），III型（n=19），IV型（n=9），分别为：在我们的系列主要和主要辅助技术成功率分别为88%（44/50）和92%（46/50）。1例患者在第1天死于术中动脉瘤破裂。在2例患者中，肾动脉丢失，1例由于破裂，1例由于桥接覆膜支架错位。在第四名患者中，腹腔动脉无法插入导管，并且丢失。最后，在另外两名患者中，总共三条肾动脉的导管插入被证明是不可能的。这是通过一个逆行的方法，通过剖腹手术的两个肾动脉在一名患者，和脾肾旁路在另一名患者。30天死亡率为8%。6个月、1年和2年的估计生存率分别为91.2%、79.8%和69.7%。在1年和2年的各种再介入的自由度分别为81.9%和73.7%，respectively：结果完全腔内修复术的胸腹动脉瘤的高风险队列是有前途的。学习曲线应该是可以预期的。虽然需要等待更长期的结果，但胸腹动脉瘤的腔内修复术很可能在未来成为许多患者的首选治疗方案。
Background: Developments with fenestrated and branched stent grafts have opened the way to treat complex aortic aneurysms involving the visceral arteries. First reports on endovascular treatment of thoracoabdominal aneurysms have demonstrated the feasibility of the technique.Methods: A literature review and results of first 50 patients treated with a custom-made Zenith device with fixed branches are presented. Most of the patients were refused open surgery mainly for the extent of the disease combined with co-morbidity, which included in most patients a combination of several risk factors. Mean aneurysm size was 71 mm and extent of the aneurysm was type I (n=9), type II (n=13), type III (n=19), and type IV (n=9), respectively.Results: Primary and primary assisted technical successes in our series were 88% (44/50) and 92% (46/50), respectively. One patient died on day 1 from an intraoperative aneurysm rupture. In two patients a renal artery was lost, one due to rupture and one due to malpositioning of the bridging stent graft. In a fourth patient, a celiac artery could not be catheterised and was lost. Finally, in two more patients, catheterisation of in total three renal arteries proved impossible. This was solved by a retrograde approach for two renal arteries via laparotomy in one patient, and a spleno-renal bypass in the other patient. Thirty-day mortality was 8%. Estimated survival at 6 months, 1 year, and 2 years was 91.2%, 79.8%, and 69.7%, respectively. Freedom of reintervention of all kinds at 1 and 2 years was 81.9% and 73.7%, respectively.Conclusion: Results of fully endovascular repair of thoracoabdominal aneurysms in a high-risk cohort are promising. A learning curve should be expected. Although longer term results need to be awaited, it is likely that endovascular repair of thoracoabdominal aneurysms will become a preferential treatment option for many patients in the future.