复杂主动脉病变的腔内治疗和杂交手术

目的：总结复杂主动脉病变腔内治疗和杂交手术的疗效和近中期结果。方法：回顾性分析2003年4月—2012年12月间收治的53例复杂主动脉病变患者的临床资料,其中男39例,女14例;年龄31~82岁,平均55岁;主动脉夹层35例,主动脉弓动脉瘤2例,腹主动脉瘤16例;其中5例合并髂动脉瘤。分别采用不同的腔内技术和/或杂交手术治疗。结果：全组患者手术技术成功率100%。术中即刻发生I型内漏8例,2例在其近端加一Cuff后内漏消失,其他患者未作特殊处理。随访1~72个月,平均20.2个月,无移植物移位及器官缺血。随访患者中无I型内漏发生,发生II型内漏2例,未行特殊处理,后自愈;无截瘫病例;1例高龄腹主动脉瘤患者术后1个月死于痰堵塞导致的窒息。结论：腔内治疗和杂交手术治疗复杂主动脉病变具有较好的近、中期疗效,远期疗效有待进一步评估。

Endovascular surgery and hybrid procedures for complex aortic diseases

Objective: To assess the efficacy and short- and mid-term results of endovascular surgery and hybrid surgical procedures in treatment of complex aortic pathology. Methods: The clinical data of 53 patients with complex aortic diseases admitted from April 2003 to December 2012 were retrospectively analyzed. Of the patients, 39 cases were male and 14 cases were female, and their ages ranged from 31 to 82, with an average age of 55 years; 35 had aortic dissection, 2 cases had aortic arch aneurysm, and 16 cases had abdominal aortic aneurysm; 5 cases were complicated with iliac artery aneurysms. Different endovascular techniques, and/or hybrid procedures were performed in these patients. Results: The technical success rate was 100% for the entire group of patients. Type I endoleak occurred in 8 patients immediately after stent-graft placement, which in 2 cases disappeared after a proximal Cuff placement, and in the remaining cases required no special treatment. Follow-up was conducted for 1 month to 72 months, with an average of 20.2 months, and no stent-graft migration or organ ischemia was noted. In the follow-up patients, no type I endoleak occurred but type II endoleak was found in 2 cases, which resolved without treatment; no patient had paraplegia, but one elderly patient with abdominal aortic aneurysm died one month after operation due to asphyxia resulting from viscous sputum. Conclusion: Endovascular surgery and hybrid procedures have demonstrable short- and mid-term efficacy in treatment of complex aortic diseases. Their long term efficacy, however, needs further evaluation.