IV型胸腹动脉瘤的管理

C.-M. Wahlgren, E. Wahlberg
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引用次数: 1

摘要

背景IV型胸腹动脉瘤(TAA-IV)仅代表少数主动脉瘤,但由于它是一种完全位于腹部的动脉瘤,血管外科医生很可能在实践中看到此类动脉瘤。综述了目前TAA IV的外科治疗方法。方法PubMed/Medline对TAA IV的文献检索。结果和结论需要进行详细的术前评估,以确定破裂和手术风险。TAA IV的选择性修复建议阈值大小为5.5–6 cm,然后根据年龄和其他风险因素进行调整。在文献中,采用夹缝法获得短主动脉交叉夹闭时间的手术简便性似乎得到了大多数支持。似乎很少需要辅助治疗来预防内脏和脊髓缺血。在没有术前肾功能障碍或肾动脉狭窄的患者中,无并发症的修复具有最小的神经损伤风险和需要透析的肾衰竭风险。血管内修复这些动脉瘤的作用还有待确定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prise en charge des anévrismes thoracoabdominaux de type IV

Background. – Thoracoabdominal aneurysm type IV (TAA IV) represents only a minority of aortic aneurysms, but as it is an entirely abdominally located aneurysm, vascular surgeons are likely to see such aneurysms in their practice. The current surgical management of TAA IV is reviewed.

Methods. – A PubMed/Medline-literature search for TAA IV.

Results and conclusions. – A detailed preoperative evaluation to determine the rupture and operative risk is required. A threshold size of 5.5–6 cm is recommended for elective repair of TAA IV, which then is adjusted for age and other risk factors. Operative simplicity with the clamp and sew approach to obtain a short aortic cross-clamp time seems to have most support in the literature. The necessity of adjunct treatment to prevent visceral and spinal cord ischemia seems to be needed rarely. Uncomplicated repair has a minimal risk of neurological injury and a low risk of renal failure requiring dialysis in patients without preoperative renal dysfunction or renal artery stenosis. The role of endovascular repair of these aneurysms remains to be established.

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