Is Hybrid Procedure the Best Treatment Option for Thoraco-Abdominal Aortic Aneurysm?
Is Hybrid Procedure the Best Treatment Option for Thoraco-Abdominal Aortic Aneurysm?
复制标题
DOI：
10.1016/j.ejvs.2009.03.018
复制
发表时间：
2009-07-01
影响因子：
5.7
通讯作者：
Logaldo, D.
中科院分区：
文献类型：
--
作者：
Chiesa, R.;Tshomba, Y.;Logaldo, D.
目的：混合胸腹主动脉瘤 (TAAA) 修复术，包括腹主动脉内脏分支重新走线，然后排除 TAAA 内移植物，已被证明是一种可行的策略，特别是对高危患者有吸引力。 患者和方法：我们分析了 31 名在我们中心接受混合 TAAA 修复术的高危患者，这些患者采用各种内脏重新走线配置和市售胸主动脉瘤内移植物。共进行了 23 例同步手术 (74.2%) 和 8 例分期手术 (25.8%)，其中 10 例 (32.3%) 进行了四支血管血运重建，6 例 (19.4%) 进行了三支血管重建，15 例 (48.4%) 进行了两支血管重建。我们还对主要的单中心 TAAA 混合修复系列进行了文献综述。结果：我们的系列中没有观察到术中死亡，血管内 TAAA 修复的技术成功率为 100%，围手术期总体死亡率为 19.4%，围手术期发病率为 35.5%，其中包括 1 例（3.2%）永久性截瘫。在中位随访 11.9 个月时，我们观察到内脏移植物闭塞率为 6.8%，1 例 II 型内漏和 1 例内移植物迁移。从文献综述中，发现了另外 6 个具有 10 多个混合 TAAA 修复的单中心系列。根据 107 名患者的现有数据，我们观察到平均围手术期死亡率为 15.6%，原发性内漏发生率为 17.9%，截瘫/轻瘫发生率为 7.2%，肾衰竭发生率为 9.9%，其他主要围手术期并发症占 50.6%。随访期间内脏移植物闭塞率为5.1%。结论：混合修复尚未消除传统TAAA开放手术的典型并发症，迄今为止已报道了显着的死亡率和发病率。需要仔细评估内脏搭桥的命运以及内漏和其他内移植物相关并发症的发生率。如今，混合 TAAA 修复应仅限于作为不适合传统开放修复的患者的简单观察的替代方案。 (C) 2009 年欧洲血管外科学会。由爱思唯尔有限公司出版。保留所有权利。
Objective: Hybrid thoraco-abdominal aortic aneurysm (TAAA) repair, consisting in re-routing of abdominal aortic visceral branches followed by TAAA endograft exclusion has been shown to be a feasible strategy, especially appealing in high-risk patients.Patients and methods: We analysed 31 high-risk patients who underwent hybrid TAAA repair in our centre with a variety of visceral re-routing configuration and of commercially available thoracic endografts. Twenty-three simultaneous (74.2%) and eight staged procedures (25.8%) were performed with a four-vessel re-vascularisation in 10 cases (32.3%), a three-vessel in six (19.4%) and a two-vessel in 15 (48.4%). We also performed a literature review of major single-centre series of TAAA hybrid repair.Results: No intra-operative deaths were observed in our series, with a technical success in endovascular TAAA repair of 100%, an overall perioperative mortality of 19.4% and a perioperative morbidity of 35.5%, including one case (3.2%) of permanent paraplegia. At a median follow-up of 11.9 months, we observed a visceral graft occlusion rate of 6.8%, one type II endoleak and one endograft migration. From the literature review, six other single-centre series with more than 10 hybrid TAAA repairs were found. From data available of 107 patients, we observed a mean perioperative mortality of 15.6%, the rate of primary endoleaks was 17.9%, paraplegia/paraparesis 7.2% and renal failure 9.9%, with other major perioperative complications reported in the 50.6% of cases. At the follow-up period visceral graft occlusion rate was 5.1%.Conclusion: Typical complications of conventional TAAA open surgery have been not eliminated by hybrid repair and significant mortality and morbidity have been reported till date. The fate of visceral bypasses and incidence of endoleak and other endograft-related complications need to be carefully assessed. Hybrid TAAA repair should nowadays be limited as alternative to simple observation in patients unfit for the conventional open repair. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.