Modern Open Surgery for Coral Reef Aorta with Visceral Artery Involvement.

IF 5.7 1区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Aurelien Hostalrich, Romain Hurtado, Thibaut Boisroux, Barbara Garmy-Susini, Jean Baptiste Ricco, Xavier Chaufour
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引用次数: 0

Abstract

Objective: Coral reef atherosclerosis of the visceral aorta (CRA) is associated with renovascular hypertension (RVH), chronic mesenteric ischaemia (CMI), and malperfusion of the lower limbs. The outcomes of open surgery for this rare disease are described in this paper.

Methods: This retrospective study included all patients who underwent open surgical repair of CRA at a single high volume referral centre between January 2009 and June 2023. The operation was preceded by pre-operative computed tomography angiography (CTA). Follow up was carried out to assess clinical improvement regarding walking, blood pressure control, and visceral and renal ischaemia. Post-operative survival and patency of the aorta and revascularised visceral arteries were evaluated by the Kaplan-Meier method.

Results: Thirty eight patients, with a mean age of 65 years and predominantly women (57.9%), were included in the study. The surgical indication was RVH in 40.6%, CMI in 25%, and malperfusion of the lower limbs in 71.9% of patients. All procedures were performed by left lumbotomy, with re-implantation or visceral and or renal artery bypass in 15 patients (39.5%) and 17 (44.7%) cases of simultaneous infrarenal aortic revascularisation. One death (2.6%) secondary to acute mesenteric ischaemia occurred post-operatively. Three patients (7.9%) presented with myocardial infarction and 11 (28.9%) with post-operative acute kidney failure without haemodialysis. Median follow up was 32.5 months. Post-operatively, all patients with CMI and claudication became asymptomatic, and 17 (56.7%) showed improved hypertension. Six patients needed repeat visceral artery revascularisation. No CRA related death occurred during follow up. Survival rates were 91.9% and 61.6% at one and five years, respectively.

Conclusion: Visceral aortic endarterectomy by left sided lumbotomy, preceded by multiplanar reconstruction CTA, is a safe and effective procedure for CRA, with low operative mortality and acceptable morbidity rates. Long term clinical monitoring by colour duplex scan or CTA is recommended due to a risk of re-stenosis of the endarterectomised visceral arteries.

内脏动脉受累的珊瑚礁主动脉现代开放手术。
目的:内脏主动脉珊瑚礁动脉粥样硬化(CRA)与新血管性高血压(RVH)、慢性肠系膜缺血(CMI)和下肢灌注不良(PAD)有关。本文介绍了这种罕见疾病的开放手术治疗效果:这项回顾性研究纳入了 2009 年 1 月至 2023 年 6 月期间在一家大型转诊中心接受开腹手术修复 CRA 的所有患者。手术前均进行了计算机断层扫描(CTA)。随访评估了患者在行走、血压控制、内脏和肾脏缺血等方面的临床改善情况。采用 Kaplan-Meier 法评估了术后存活率以及主动脉和血管再通的内脏动脉的通畅情况:研究共纳入 38 名患者,平均年龄 65 岁,以女性为主(57.9%)。40.6%的患者手术指征为RVH,25%为CMI,71.9%为PAD。所有手术均通过左腰切开术进行,15 名患者(39.5%)进行了再植或内脏/肾动脉搭桥术,17 名患者(44.7%)同时进行了肾下主动脉血运重建术。术后有一名患者(2.6%)因急性肠系膜缺血而死亡。3名患者(7.9%)出现心肌梗死,11名患者(28.9%)术后出现急性肾衰竭,但未进行血液透析。中位随访时间为 32.5 个月。术后,所有患有 CMI 和跛行的患者均无症状,17 名(56.7%)患者的高血压有所改善。有六名患者需要再次进行内脏动脉再通术。随访期间没有发生与 CRA 相关的死亡事件。一年和五年的存活率分别为91.9%和61.6%:内脏主动脉内膜剥脱术是一种安全有效的 CRA 手术,手术死亡率低,发病率可接受。由于内脏动脉内膜切除术后存在再狭窄的风险,建议通过彩色双相扫描或 CTA 进行长期临床监测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.80
自引率
15.80%
发文量
471
审稿时长
66 days
期刊介绍: The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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