胸主动脉降支的紧急血管内介入治疗:单中心经验。

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Emergency Medicine International Pub Date : 2023-01-03 eCollection Date: 2023-01-01 DOI:10.1155/2023/6600035
Piotr Buczkowski, Mateusz Puslecki, Marcin Ligowski, Marek Dabrowski, Sebastian Stefaniak, Zuzanna Fryska, Jerzy Kulesza, Robert Juszkat, Marek Jemielity, Bartlomiej Perek
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引用次数: 0

摘要

背景:目的:本研究旨在分析胸腔内血管主动脉修复术(TEVAR)治疗涉及降主动脉的急性外科急症的有效性:方法:对2007年以来在一个中心接受TEVAR手术的所有患者的病历进行回顾性分析。急诊主动脉疾病患者的纳入标准为复杂性自发性急性主动脉综合征(csAAS)、创伤性主动脉急性损伤(TAI)以及其他需要紧急干预的适应症。根据血管外科学会胸腔内血管主动脉修补术(TEVAR)报告标准,对技术和临床成功率、患者死亡率、存活率和再手术率进行了评估:结果:74 例(51.0%)患者需要进行紧急干预,其中包括复杂性自发性急性主动脉综合征(csAAS)(64.8%;n = 48)和创伤性主动脉急性损伤(TAIs)(31.1%)患者。此外,还诊断出一例主动脉先天性夹层(AID)和另外两例植入支架后的瘘管。所有手术都是通过手术暴露的股动脉完成的,而 2 例混合手术则需要额外的方法。主要技术成功率为 95.9%,3 例出现内漏。主要临床成功率为 94.5%。所有患者都在血管内介入手术后存活了下来,但在住院期间,其中一名患者因多器官功能衰竭而死亡(早期死亡率为1.3%)。在长达 6 到 164 个月(中位数 67 个月)的随访期间,有 11 名患者死亡。年度、五年和十年生存概率分别为 86.4 ± 0.04%、80.0 ± 0.05% 和 76.6 ± 0.06%。然而,TAI(95.2%)术后的五年存活率明显高于 scAAS(63.4%)(P=0.008)。术后早期,一人出现一过性偏瘫(1.3%)。出院后随访期间未发现其他与支架移植物相关的严重不良事件:结论:需要紧急干预的降主动脉病变可通过血管内技术进行治疗,在经验丰富的专业团队中效果最佳,发病率和死亡率较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience.

Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience.

Emergency Endovascular Interventions on Descending Thoracic Aorta: A Single-Center Experience.

Background: Implementation of emergency endovascular aortic repair provides an attractive opportunity in the treatment of complicated acute aortic syndromes involving descending aorta.

Aim: The aim of this study was to analyze the effectiveness of thoracic endovascular aortic repair (TEVAR) for the treatment of acute surgical emergencies involving the descending thoracic aorta.

Methods: A retrospective review of the medical records of all patients undergoing TEVAR in a single center since 2007 was undertaken. Patients with the aortic disease treated on emergency inclusion criteria were complicated spontaneous acute aortic syndrome (csAAS), traumatic aortic acute injuries (TAIs), and other indications requiring emergent intervention. Technical and clinical success with patient mortality, survival, and reoperation rate was evaluated according to Society for Vascular Surgery reporting standards for thoracic endovascular aortic repair (TEVAR).

Results: The emergency interventions were necessary in 74 cases (51.0%), including patients with the complicated spontaneous acute aortic syndrome (csAAS) (64.8%; n = 48) and traumatic aortic acute injuries (TAIs) (31.1%). In addition, in one case aortic iatrogenic dissection (AID) and in 2 other fistulas after the previous stent graft, implantations were diagnosed. All procedures were done through surgically exposed femoral arteries while 2 hybrid procedures required additional approaches. The primary technical success rate was 95.9%, in 3 cases endoleak was reported. The primary clinical success occurred in 94.5%. All patients survived the endovascular interventions, whereas during in-hospital stay one of them died due to multiorgan failure (early mortality 1.3%). During the follow-up period, lasting 6 through 164 months (median 67), 11 patients died. Annual, five- and ten-year probability of survival was 86.4 ± 0.04%, 80.0 ± 0.05%, and 76.6 ± 0.06%, respectively. However, the rate of 5-year survivors was significantly higher after TAI (95.2%) than scAAS (63.4%) (p=0.008). Early after the procedure, one individual developed transient paraparesis (1.3%). No other serious stent-graft-related adverse events were noted within the postdischarge follow-up period.

Conclusions: Descending aortic pathologies requiring emergent interventions can be treated by endovascular techniques with optimal results and low morbidity and mortality in an experienced and dedicated team.

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来源期刊
Emergency Medicine International
Emergency Medicine International EMERGENCY MEDICINE-
CiteScore
0.10
自引率
0.00%
发文量
187
审稿时长
17 weeks
期刊介绍: Emergency Medicine International is a peer-reviewed, Open Access journal that provides a forum for doctors, nurses, paramedics and ambulance staff. The journal publishes original research articles, review articles, and clinical studies related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care, sports medicine, wound care, and toxicology.
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