Endovascular stent-graft management of thoracic aortic diseases
Endovascular stent-graft management of thoracic aortic diseases
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DOI：
10.1016/s0720-048x(01)00341-2
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发表时间：
2001-07-01
影响因子：
3.3
通讯作者：
Dake, MD
中科院分区：
文献类型：
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作者：
Dake, MD
胸降主动脉瘤（TAA）的传统标准治疗是开放手术修复，用移植物替代病变主动脉段。尽管过去 30 年在手术技术、麻醉管理和术后皮重方面取得了重要进展，但手术的死亡率和发病率仍然相当高，特别是对于因共存严重心肺异常或其他内科疾病而处于开胸手术高风险的患者。血管内覆膜支架技术的出现为特定的 TAA 患者提供了开放手术的替代方案。初步经验表明，覆膜支架治疗可能会降低 TAA 修复的手术风险、医院死亡率和手术费用。这些潜在的好处对于开放 TAA 修复的高风险患者尤其有吸引力。目前血管内 TAA 治疗的结果显示，手术死亡率在 0% 到 4% 之间，90% 到 100% 的病例出现动脉瘤血栓，0% 到 1.6% 的患者出现截瘫并发症。 TAA覆膜支架修复的早期成功促进了这些装置在治疗各种胸主动脉病变中的应用，包括急性和慢性夹层、壁内血肿、穿透性溃疡、创伤性损伤和其他疾病。在对这些新设备的一般使用做出有信心的建议之前，我们迫切等待对特定类型主动脉疾病患者的支架移植物治疗与手术治疗的结果进行比较的前瞻性对照试验的结果。 (C) 2001 Elsevier Science Ireland Ltd. 保留所有权利。
The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative tare over the last 30 years, the mortality and morbidity pf surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital slay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.