Mid-term results of an endovascular stent-graft by means of median sternotomy for distal aortic arch aneurysm.
Mid-term results of an endovascular stent-graft by means of median sternotomy for distal aortic arch aneurysm.
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通过胸骨正中切开术治疗远端主动脉弓动脉瘤的血管内覆膜支架的中期结果。
DOI：
10.1046/j.1525-1594.2002.07027.x
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发表时间：
2002
影响因子：
2.4
通讯作者：
T. Ishiguchi
中科院分区：
文献类型：
--
作者：
A. Usui;Y. Ueda;T. Akita;Y. Takagi;K. Tajima;N. Nishikimi;T. Ishiguchi
移位和移植物周围渗漏是通过胸骨正中切开术治疗远端主动脉弓动脉瘤的血管内支架移植（EVG）后的主要问题。已应用锚定缝合线来防止这些问题。我们评估中期结果和锚定缝合线的功效。手术对象为 19 名男性和 2 名女性，平均年龄 70 岁（范围：59-81 岁）。动脉瘤为 19 个真性动脉瘤（12 个梭形动脉瘤、7 个囊状动脉瘤）、1 个慢性夹层动脉瘤和 1 个主动脉穿透性溃疡。逆行脑灌注经主动脉弓植入EGV 13例，选择性脑灌注8例。全弓置换2例，主动脉冠状动脉搭桥术4例。锚定缝线固定EVG 9例。平均随访期为 28 个月（范围：2-56）。无手术死亡，但发生截瘫1例、脑卒中1例、暂时性脊髓功能障碍2例。所有动脉瘤在手术后完全血栓形成，直径减小（66.9 +/- 17.4 mm 至 57.3 +/- 15.7 mm，p < 0.0001）。 4 名患者出现 EVG 相关并发症。慢性B型夹层术后1年发现因假腔感染即将破裂，需重做手术。 3 名患者发生迁移，均为梭形动脉瘤。其中一人一年后发生了移植扭结。另一位患者术后3年出现动脉瘤肿大并伴有浆液性胸腔积液。第三例因术后 3 年出现移植物周围渗漏而需要重做手术。有 2 人因中风导致晚期死亡。 9例采用锚定缝合的病例和7例囊状动脉瘤病例均未出现EVG相关并发症。 8例在开放主动脉的同时经双侧腋动脉低流量顺行灌注，未出现脊髓功能障碍。 Logistic 回归分析显示，与直径大于 80 毫米的大动脉瘤的并发症显着相关。大动脉瘤往往会引起涉及 EVG 迁移的并发症。 EVG 锚定缝合可以预防 EVG 相关并发症。
Migration and perigraft leakage are major problems after endovascular stent graft (EVG) by means of median sternotomy for distal aortic arch aneurysm. Anchoring sutures have been applied to prevent these problems. We evaluate the mid-term results and the efficacy of anchoring sutures. The operation was performed on 19 men and 2 women with a mean age of 70 years (range, 59-81). The aneurysms were 19 true (12 fusiform, 7 saccular), 1 chronic dissection, and 1 penetrating aortic ulcer. EGVs were implanted by way of the aortic arch under retrograde cerebral perfusion in 13 patients and selective cerebral perfusion in 8. Total arch replacement was performed in 2 patients, and aortocoronary bypass grafting in 4. Anchoring sutures to fix the EVG were applied in 9 patients. The average follow-up period was 28 months (range, 2-56). There were no operative mortalities, but 1 paraplegia, 1 stroke, and 2 cases of temporary spinal cord dysfunction occurred. All aneurysms were thrombosed completely after surgery and reduced in diameter (66.9 +/- 17.4 mm to 57.3 +/- 15.7 mm, p < 0.0001). EVG-related complications arose in 4 patients. A chronic Type B dissection revealed impending rupture because of false lumen infection 1 year after operation, and redo surgery was performed. Migration occurred in 3 patients, all with fusiform aneurysms. One of these had a graft kink 1 year later. Another showed aneurysm enlargement with serous pleural effusion 3 years after operation. The third required redo surgery because of perigraft leakage at 3 years after surgery. There were 2 late deaths caused by stroke. There were no EVG-related complications in the 9 cases in which anchoring sutures were applied and in the 7 cases with saccular aneurysms. No spinal cord dysfunction occurred in 8 cases with low-flow antegrade perfusion by way of both axillary arteries while the aorta was opened. Logistic regression analysis showed significant relevance to complications of large aneurysms, greater than 80 mm in diameter. A large aneurysm tends to give rise to complications involving EVG migration. Anchoring sutures of EVG may prevent EVG-related complications.