Two-Year Single-Center Experience with Thoracic Endovascular Aortic Repair Using the EndoFit Thoracic Stent-Graft
Two-Year Single-Center Experience with Thoracic Endovascular Aortic Repair Using the EndoFit Thoracic Stent-Graft
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使用 EndoFit 胸主动脉覆膜支架进行胸主动脉腔内修复的两年单中心经验
DOI：
10.1583/08-2364.1
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
D. Raithel
中科院分区：
文献类型：
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作者：
L. Qu;D. Raithel
目的：分析我们使用EndoFit胸主动脉覆膜支架行胸主动脉瘤腔内修复术（TEVAR）的单中心经验。研究方法：对2005年12月至2007年12月期间使用EndoFit胸主动脉覆膜支架接受TEVAR的87例连续患者（64例男性;中位年龄67.8±8.7岁，范围24-88岁）进行了回顾性分析。略多于一半的患者（n=46）患有胸主动脉瘤，而41例患有胸主动脉夹层。17例为急诊手术。所有患者在出院前、1个月、3个月和6个月以及此后每年进行影像学随访。结果：技术成功率100%。55例（63.2%）患者接受了不同的脱支手术，以延长近端或远端锚定区。住院及30天死亡率为9.2%（8/87）。8例（9.3%）患者发生神经系统并发症，包括5例卒中（2例死亡）和3例截瘫。1例术中升主动脉脱支吻合术大出血在泵的帮助下得以抢救。5例患者出现即刻近端I型内漏; 3例使用近端套囊进行补救，1例使用三叶球囊进行补救，1例未进行治疗。仍观察到1例II型内漏。平均随访时间为15.2个月（范围5-29），在此期间，10例（11.5%）患者死于与动脉瘤或覆膜支架无关的原因。所有解剖外旁路和覆膜支架均通畅;未检测到覆膜支架扭结、塌陷或脱位。两例TEVAR术后近端内漏在脱支后使用近端套囊进行补救。TEVAR术后无破裂或转为开放手术。结论：我们使用EndoFit系统进行TEVAR的2年单中心经验表明，技术成功率高，器械或血管内分泌相关并发症的发生率低。柔性亲水性导引器易于插入并通过血管系统跟踪。扩展着陆区的去支技术不仅拓宽了TEVAR的适用性，而且减少了TEVAR后的并发症。
Purpose: To analyze our single-center experience of thoracic endovascular aortic aneurysm repair (TEVAR) using the EndoFit Thoracic Aortic Endograft. Methods: A retrospective review was conducted of 87 consecutive patients (64 men; median age 67.8±8.7 years, range 24–88) undergoing TEVAR using the EndoFit thoracic stent-graft from December 2005 to December 2007. Slightly more than half (n=46) of the patients had thoracic aortic aneurysm, while 41 had thoracic aortic dissection. Seventeen cases were performed emergently. All patients had imaging follow-up before discharge; at 1, 3, and 6 months; and annually thereafter. Results: The technical success rate was 100%. Fifty-five (63.2%) patients had different debranching procedures to extend the proximal or distal landing zone. The in-hospital and 30-day mortality rate was 9.2% (8/87). Neurological complications occurred in 8 (9.3%) patients, including 5 strokes (2 fatal) and 3 cases of paraplegia. One intraoperative massive bleeding from an ascending aortic debranching anastomosis was rescued with the aid of a pump. Five patients had immediate proximal type I endoleak; 3 were remedied with a proximal cuff, 1 was rescued with tri-lobe balloon, and 1 was left untreated. One type II endoleak remains under observation. The average follow-up was 15.2 months (range 5–29), during which 10 (11.5%) patients died of causes unrelated to the aneurysm or stent-graft. All the extra-anatomical bypasses and stent-grafts were patent; no stent-graft kinking, collapse, or dislocation was detected. Two post-TEVAR proximal endoleaks were remedied with a proximal cuff after debranching. There was no post-TEVAR rupture or conversion to open surgery. Conclusion: Our 2-year single-center experience using the EndoFit system for TEVAR showed a high technical success rate and a low incidence of device- or aneurysm-related complications. The flexible, hydrophilic introducer was easy to insert and track through the vasculature. The debranching techniques to extend the landing zones not only broaden the applicability of TEVAR but also reduce post-TEVAR complications.