Secondary surgical procedures after endovascular stent grafting of the thoracic aorta: successful approaches to a challenging clinical problem.
Secondary surgical procedures after endovascular stent grafting of the thoracic aorta: successful approaches to a challenging clinical problem.
复制标题
胸主动脉血管内支架移植后的二次外科手术：解决具有挑战性的临床问题的成功方法。
DOI：
10.1016/j.jtcvs.2008.05.053
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
F. Mohr
中科院分区：
文献类型：
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作者：
E. Girdauskas;V. Falk;T. Kuntze;M. Borger;A. Schmidt;D. Scheinert;F. Mohr
目的评价开放手术治疗胸主动脉支架置入术后并发症的效果。方法14例患者，男8例，平均年龄(59.8±14.8)岁，在胸主动脉支架置入后5年内接受常规手术治疗。结果支架植入术适应证为B型主动脉夹层10例，扩张性退行性胸主动脉瘤3例，假性动脉瘤1例。支架置入后与传统手术的中位间隔时间为4.5个月(0.1~49个月)。手术指征：持续性I型内漏伴动脉瘤进行性增大7例，主动脉-食管瘘2例，逆行A型夹层2例，人工血管感染2例，非冠脉及右冠脉瓣膜穿孔致主动脉瓣关闭不全1例。有9例(%)患者需要取出内膜，5例(36%)患者需要胸腹主动脉置换。住院病死率为7%(1例)。无一例术后发生中风或瘫痪。术后平均(13.5±10.1)个月(1~36个月)存活11例(79%)。结论胸主动脉支架置入术后的二次手术效果良好。在血管内治疗日益增多的时代，为这一棘手的临床问题确定成功的手术策略是很重要的。
OBJECTIVETo evaluate the results of open surgical repair for complications after endovascular thoracic aorta stenting.METHODSA total of 14 patients (8 male, mean age 59.8 ± 14.8 years) underwent conventional surgical therapy at our institution over a 5-year period after previous thoracic aortic stent implantation. The indications for surgery, intraoperative strategy, and perioperative and follow-up results were analyzed.RESULTSThe indication for stent implantation was type B aortic dissection in 10 patients, expanding degenerative thoracic aneurysm in 3 patients, and pseudoaneurysm in 1 patient. The median interval to conventional surgery after stent implantation was 4.5 months (range 0.1–49 months). The indication for surgery was persistent type I endoleak with progressive aneurysm enlargement in 7 patients, aortoesophageal fistula in 2 patients, retrograde type A dissection in 2 patients, infection of the endoprosthesis in 2 patients, and aortic valve insufficiency caused by perforation of noncoronary and right coronary cusps in 1 patient. The endograft had to be removed in 9 (64%) patients, and 5 (36%) patients required replacement of the thoracoabdominal aorta. In-hospital mortality was 7% (1 patient). No patients had a postoperative stroke or paraparesis. Eleven (79%) patients are alive after a mean follow-up of 13.5 ± 10.1 months (range 1–36 months).CONCLUSIONSSecondary surgical procedures after stenting of the thoracic aorta can be performed with very good results, despite the challenging clinical scenarios. Identification of successful surgical strategies for this difficult clinical problem is important in the era of increasing endovascular therapy.