Stent grafting for aneurysmal degeneration of chronic descending thoracic aortic dissections

作者：Nathan Derek P; Woo Edward Y; Fairman Ronald M; Wang Grace J; Pochettino Alberto; Desai Nimesh D; Bavaria Joseph E; Jackson Benjamin M^*

来源：Journal of Vascular Surgery, 2012, 55(4): 963-967.

DOI：10.1016/j.jvs.2011.11.003

Objective: The objective of this study was to examine the results of thoracic endovascular aneurysm repair (TEVAR) for chronic descending thoracic aortic (DTA) dissections with aneurysmal degeneration.
Methods: Over 70 months at a single institution, 27 patients underwent TEVAR for aneurysms related to chronic (>6 weeks) DTA dissections.
Results: Mean patient age was 67.5 +/- 9.6 years; 18 were men. Primary indications for repair were aneurysm size (n = 20), rapid aneurysmal growth (n = 5), saccular aneurysm (n = 1), and rupture (n = 1). Preoperative false lumen status was patent in 18 patients, partially thrombosed in 8 patients, and unknown in the patient whose aneurysm ruptured. The proximal entry tear was covered in all 27 patients. Fourteen patients required coverage of the left subclavian artery, of which 9 patients underwent prophylactic revascularization. On completion angiogram, no patient had antegrade perfusion of the aneurysmal false lumen. There were three procedural complications: 2 patients sustained paraparesis (one resolved and one improved), and 1 patient had an access injury requiring stent graft placement. Thirty-day mortality was 3.7% (1 of 27); the one death was in the patient whose aneurysm ruptured. Of the 26 surviving patients, 23 (88.5%) had thrombosis of the aneurysmal false lumen. Twenty-two patients (84.6%) had stability or decrease in maximal aneurysm diameter on last radiographic follow-up at 18 +/- 20 months. Three-year Kaplan-Meier survival was 90.3% +/- 6.5% in the 26 patients who survived to hospital discharge, with a mean follow-up of 27.3 +/- 22.1 months. In patients with preoperatively partially thrombosed false lumens (n = 8), 3-year survival was 100%.
Conclusions: TEVAR for aneurysms due to chronic dissections of the DTA can be performed safely and effectively at midterm follow-up according to this single-institution study. Stent graft therapy may be of particular benefit in patients presenting with partially thrombosed false lumens. (J Vasc Surg 2012;55:963-7.)

• 出版日期2012-4