Ten-year experience of the thoraco-abdominal aortic aneurysm treatment using a hybrid thoracic endovascular aortic repair.
Ten-year experience of the thoraco-abdominal aortic aneurysm treatment using a hybrid thoracic endovascular aortic repair.
复制标题
混合胸主动脉腔内修复术治疗胸腹主动脉瘤十年经验。
DOI：
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发表时间：
2018
影响因子：
--
通讯作者：
H. Mori
中科院分区：
文献类型：
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作者：
T. Shuto;T. Wada;S. Miyamoto;Noritaka Kamei;N. Hongo;H. Mori
目标
胸腹主动脉瘤的治疗仍然具有很高的死亡率和截瘫率。在超级老龄化社会中，进行微创手术的方法仍然是一个主要问题。我们回顾了我们10年来使用内脏重建和胸主动脉腔内修复联合手术治疗胸腹主动脉瘤的经验。
方法
2007年至2016年期间，60例患者接受了混合修复术治疗胸腹主动脉瘤。平均年龄为72.7岁。43例（72%）患者发现了真正的动脉瘤，17例（28%）患者发现了慢性夹层。标准手术程序包括用人工移植物替换腹主动脉，并使用四叉移植物重建内脏动脉。肾内脏脱支和支架植入术作为2阶段手术进行。
结果
住院死亡率为5%。2例（3%）患者在肾内脏脱支后不久死于动脉瘤破裂。另2例患者在预防性肾内脏脱支术后长期死于动脉瘤破裂。2例（3%）患者在支架植入术后发生脊髓缺血。4例（7%）患者在随访期间需要额外治疗。2年、5年和8年的总生存率分别为75.9%、65.2%和43.5%。2年、5年和8年时无血栓相关事件的比率分别为92.9%、80.5%和72.5%。
结论
混合修复被认为是老年和高危患者的良好选择。进一步的长期随访是必要的，以扩大年轻患者的适应症。
OBJECTIVES
The treatment of thoraco-abdominal aortic aneurysm continues to have a high mortality and paraplegia rate. In superaging societies, the methods of performing less invasive operations remain a major issue. We reviewed our 10-year experience in the treatment of thoraco-abdominal aortic aneurysm using a hybrid procedure of combined visceral reconstruction and thoracic endovascular aortic repair.
METHODS
Sixty patients underwent a hybrid repair for the treatment of the thoraco-abdominal aortic aneurysm between 2007 and 2016. The mean age was 72.7 years. A true aneurysm was found in 43 (72%) patients and a chronic dissection in 17 (28%) patients. The standard operative procedure involved replacing the abdominal aorta with an artificial graft, and the visceral arteries were reconstructed using a quadrifurcated graft. Renovisceral debranching and stent grafting were performed as a 2-stage procedure.
RESULTS
The hospital mortality rate was 5%. Two (3%) patients died due to an aneurysmal rupture in the hospital just after renovisceral debranching. The other 2 patients died due to an aneurysmal rupture in the long-term period after preventive renovisceral debranching. Two (3%) patients experienced spinal cord ischaemia after the stenting procedure. Four (7%) patients required additional treatment during the follow-up period. The overall survival was 75.9% at 2 years, 65.2% at 5 years and 43.5% at 8 years. The rates of freedom from aorta-related events were 92.9% at 2 years, 80.5% at 5 years and 72.5% at 8 years.
CONCLUSIONS
The hybrid repair is considered to be a good option for elderly and high-risk patients. Further long-term follow-up is necessary to extend the indication in younger patients.
影响因子：
4.3
作者：
Hughes, G. Chad;Barfield, Michael E.;Shah, Asad A.;Williams, Judson B.;Kuchibhatla, Maragatha;Hanna, Jennifer M.;Andersen, Nicholas D.;McCann, Richard L.
通讯作者：
McCann, Richard L.