The assessment of collateral communication after hybrid repair for Crawford extent II thoraco-abdominal aortic aneurysms.
The assessment of collateral communication after hybrid repair for Crawford extent II thoraco-abdominal aortic aneurysms.
复制标题
Crawford II 级胸腹主动脉瘤混合修复后侧支交通的评估。
DOI：
10.1093/ejcts/ezv027
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Y. Sawa
中科院分区：
文献类型：
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作者：
T. Shijo;T. Kuratani;Y. Shirakawa;K. Torikai;K. Shimamura;T. Sakamoto;Yoshiki Watanabe;N. Maeda;N. Tomiyama;Y. Sawa
目标
广泛的胸腹主动脉瘤（TAAA）的修复是侵入性的，并且具有脊髓损伤（SCI）的高风险。本研究的目的是评估Crawford II级主动脉瘤混合修复后的早期结果和脊髓侧支循环。
方法
在1997年至2013年期间，我们对TAAA进行了128例胸主动脉腔内修复术（TEVAR）。本研究回顾了12例接受混合TEVAR治疗Crawford II级主动脉瘤的患者（平均年龄：56岁，6例男性，慢性夹层：10例）。在TEVAR之前的不同阶段进行主动脉弓修复以创建近端锚定区，并进行内脏去分支旁路以创建远端锚定区。随后，展开覆膜支架以覆盖残留的下游主动脉。TEVAR通常在最终脱支程序后的第二天进行。所有病例均行脑脊液引流，平均血压维持在>90 mmHg。
结果
TEVAR的中位手术时间为94 min（范围：71-421 min），平均失血量为300 ml（范围：130-1350 ml）。TEVAR后未观察到SCI或院内死亡。多探测器计算机断层扫描确定了三个动脉（锁骨下动脉，髂外动脉和髂内动脉）提供侧支循环脊髓节段动脉（SA）。在所有病例中，胸中部SA（Th 5 -8）和下腰椎SA（L2-5）分别由锁骨下动脉和髂内动脉供血。此外，下胸至高腰SA（Th 9-L1）通过胸外侧壁与锁骨下动脉和/或通过腹壁与髂外动脉连通。
结论
我们对Crawford II期TAAA进行了混合修复，取得了令人满意的早期和中期结局。此外，无论主动脉修复的程度如何，在TEVAR期间和之后都维持了SA的侧支循环。
OBJECTIVES
The repair of extensive thoraco-abdominal aortic aneurysms (TAAAs) is invasive and carries a high risk for spinal cord injury (SCI). The aim of this study was to assess the early results and collateral circulation to the spinal cord after hybrid repair for Crawford extent II aortic aneurysms.
METHODS
Between 1997 and 2013, we performed 128 thoracic endovascular aortic repair (TEVAR) procedures for TAAAs. This study reviews 12 patients who underwent hybrid TEVAR for a Crawford extent II aortic aneurysm (mean age: 56 years, 6 men, chronic dissection: 10). Aortic arch repair was performed to create a proximal landing zone and visceral debranching bypass was performed to create a distal landing zone at separate stages prior to TEVAR. Subsequently, a stent graft was deployed to cover the residual downstream aorta. TEVAR was generally performed the day after the final debranching procedure. Cerebrospinal fluid drainage was performed, and the mean blood pressure was maintained at >90 mmHg in all cases.
RESULTS
The median operation time for TEVAR was 94 min (range: 71-421 min) and the mean blood loss was 300 ml (range: 130-1350 ml). No SCI or in-hospital death was observed after TEVAR. Multidetector computed tomography identified three arteries (subclavian artery, external iliac artery and internal iliac artery) providing collateral circulation to spinal segmental arteries (SAs). In all cases, mid-thoracic SAs (Th5-8) and low lumbar SAs (L2-5) were fed by the subclavian artery and the internal iliac artery, respectively. Additionally, low thoracic to high lumbar SAs (Th9-L1) communicated with the subclavian artery via the lateral thoracic wall and/or the external iliac artery via the abdominal wall.
CONCLUSIONS
We achieved satisfactory early and mid-term outcomes with hybrid repair for Crawford extent II TAAAs. Furthermore, collateral circulation to SAs was maintained during and after TEVAR regardless of the extent of the aortic repair.