Objectives: We sought to describe the midterm results of extensive primary rep air of the thoracic aorta by means of the modified elephant trunk technique with a stent graft for acute type A aortic dissection, particu...Objectives: We sought to describe the midterm results of extensive primary rep air of the thoracic aorta by means of the modified elephant trunk technique with a stent graft for acute type A aortic dissection, particularly the changes of t he false lumen shown by enhanced computed tomographic scanning. Methods: The sub jects were 35 consecutive patients who received arch replacement with open stent grafting for type A acute aortic dissection between December 1997 and April 200 2. The mean follow-up period was 55 months (range, 30-83 months). Computed tom ographic scanning was performed at 1, 3, 12, and 36 months postoperatively to de tect thrombosis and obliteration of the false lumen after its exclusion by the s tent graft. The diameter of the aorta was measured at 3 levels: the distal edge of the stent graft, the diaphragm, and the origin of the superior mesenteric art ery. Results: Two patients died in the initial operation, but no patients requir ed additional surgical treatment of the thoracic aorta. The mean diameter of the stent grafts was 26.2 mm, and the mean length was 8.9 cm. Thrombus formation in the false lumen was recognized at the distal edge of the graft in all patients, at the diaphragmatic level in 26 patients, and at the superior mesenteric arter y level in 15 patients. Obliteration of the false lumen was recognized at the di stal edge of the graft in all patients, at the diaphragmatic level in 20 patient s, and at the superior mesenteric artery level in 15 patients. The aorta distal to the stent graft showed minimal changes. Conclusions: In patients with acute t ype A aortic dissections, it is possible to perform extensive primary repair of the thoracic aorta with relative safety by using a synthetic graft with a self- expanding stent, and this method might reduce the necessity of further operation s not only for the distal descending aorta but also for the thoracoabdominal aor ta.展开更多
Background: Endovascular treatment of thoracic aortic diseases demonstrated low perioperative morbidity and mortality when compared with conventional open repair. Long-term effectiveness of this minimally invasive tec...Background: Endovascular treatment of thoracic aortic diseases demonstrated low perioperative morbidity and mortality when compared with conventional open repair. Long-term effectiveness of this minimally invasive technique remains to be proven. The Talent Thoracic Retrospective Registry was designed to evaluate the impact of this therapy on patients treated in 7 major European referral centers over an 8-year period. Methods: Data from 457 consecutive patients (113 emergency and 344 elective cases) who underwent endovascular thoracic aortic repair with the Medtronic Talent Thoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) were collected. Follow-up analysis (24±19.4 months, range 1-85.1 months)was based on clinical and imaging findings, including all adverse events. To ensure consistency of data interpretation and event reporting, one physician reviewed all adverse events and deaths for the whole cohort of patients. In the case of discrepancies, the treating physicians were queried. Findings: Among 422 patients who survived the interventional procedure (in-hospital mortality 5%, 23 patients), mortality during follow-up was 8.5%(36 patients), and in 11 of them the death was related to the aortic disease. Persistent endoleak was reported at imaging follow-up in 64 cases: 44 were primary (9.6%) and 21 occurred during follow-up (4.9%). Seven patients with persistent endoleak had aortic rupture during follow-up, at a variable time from 40 days to 35 months, and all subsequently died. A minor incidence of migration of the stent graft (7 cases), graft fabric alteration (2 cases), and modular disconnection (3 cases) was observed at imaging. Kaplan-Meier overall survival estimate at 1 year was 90.97%, at 3 years was 85.36%, and at 5 years was 77.49%. At the same intervals, freedom from a second procedure (either open conversion or endovascular) was 92.45%, 81.3%, and 70.0%, respectively. Conclusion: Endovascular treatment for thoracic aortic disease with the Talent stent graft is associated with low early morbidity and mortality rates also for patients who are at high risk and treated on an emergency basis. Follow-up data indicate a substantial durability of the procedure with a high freedom from related death and secondary interventions.展开更多
Background: Penetrating aortic ulcer(PAU) is increasingly acknowledged as a pathological variant of classic false- lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of pa...Background: Penetrating aortic ulcer(PAU) is increasingly acknowledged as a pathological variant of classic false- lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of patients. The objective of this study was to investigate the results of endovascular stent- graft placement for the treatment of patients with PAUs. Methods: Between July 1999 and December 2004, endovascular stent- graft repair of PAU was performed in 22 patients(69.1± 7.8 years, 16 men), 3(14% ) of whom had contained aortic rupture. Stent- graft placement was performed in the cardiac catheterization laboratory with the patient under general anesthesia, using a surgical access. Results: Procedural success was achieved in all but 1 patient(technical success rate 96% ). Postoperatively, 1(5% ) patient had minor stroke with transient amentia. There were no other inhospital complications or deaths. During a median follow- up of 27(range 1- 62) months, 1 patient underwent adjunctive stent- graft placement for type I endoleak. Three patients died unrelated to the aortic disease late during follow- up. Overall survival rates were 100% at 30 days, 100% at 1 year, 82.5% ± 11.3% at 2 years, and 61.9% ± 20.0% at 5 years. Conclusions: Endovascular stent- graft treatment is an effective treatment for patients with PAU and is associated with low procedural morbidity. Both acute and midterm mortality of this novel treatment concept appear to be favorable compared with the natural course of the disease.展开更多
文摘Objectives: We sought to describe the midterm results of extensive primary rep air of the thoracic aorta by means of the modified elephant trunk technique with a stent graft for acute type A aortic dissection, particularly the changes of t he false lumen shown by enhanced computed tomographic scanning. Methods: The sub jects were 35 consecutive patients who received arch replacement with open stent grafting for type A acute aortic dissection between December 1997 and April 200 2. The mean follow-up period was 55 months (range, 30-83 months). Computed tom ographic scanning was performed at 1, 3, 12, and 36 months postoperatively to de tect thrombosis and obliteration of the false lumen after its exclusion by the s tent graft. The diameter of the aorta was measured at 3 levels: the distal edge of the stent graft, the diaphragm, and the origin of the superior mesenteric art ery. Results: Two patients died in the initial operation, but no patients requir ed additional surgical treatment of the thoracic aorta. The mean diameter of the stent grafts was 26.2 mm, and the mean length was 8.9 cm. Thrombus formation in the false lumen was recognized at the distal edge of the graft in all patients, at the diaphragmatic level in 26 patients, and at the superior mesenteric arter y level in 15 patients. Obliteration of the false lumen was recognized at the di stal edge of the graft in all patients, at the diaphragmatic level in 20 patient s, and at the superior mesenteric artery level in 15 patients. The aorta distal to the stent graft showed minimal changes. Conclusions: In patients with acute t ype A aortic dissections, it is possible to perform extensive primary repair of the thoracic aorta with relative safety by using a synthetic graft with a self- expanding stent, and this method might reduce the necessity of further operation s not only for the distal descending aorta but also for the thoracoabdominal aor ta.
文摘Background: Endovascular treatment of thoracic aortic diseases demonstrated low perioperative morbidity and mortality when compared with conventional open repair. Long-term effectiveness of this minimally invasive technique remains to be proven. The Talent Thoracic Retrospective Registry was designed to evaluate the impact of this therapy on patients treated in 7 major European referral centers over an 8-year period. Methods: Data from 457 consecutive patients (113 emergency and 344 elective cases) who underwent endovascular thoracic aortic repair with the Medtronic Talent Thoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) were collected. Follow-up analysis (24±19.4 months, range 1-85.1 months)was based on clinical and imaging findings, including all adverse events. To ensure consistency of data interpretation and event reporting, one physician reviewed all adverse events and deaths for the whole cohort of patients. In the case of discrepancies, the treating physicians were queried. Findings: Among 422 patients who survived the interventional procedure (in-hospital mortality 5%, 23 patients), mortality during follow-up was 8.5%(36 patients), and in 11 of them the death was related to the aortic disease. Persistent endoleak was reported at imaging follow-up in 64 cases: 44 were primary (9.6%) and 21 occurred during follow-up (4.9%). Seven patients with persistent endoleak had aortic rupture during follow-up, at a variable time from 40 days to 35 months, and all subsequently died. A minor incidence of migration of the stent graft (7 cases), graft fabric alteration (2 cases), and modular disconnection (3 cases) was observed at imaging. Kaplan-Meier overall survival estimate at 1 year was 90.97%, at 3 years was 85.36%, and at 5 years was 77.49%. At the same intervals, freedom from a second procedure (either open conversion or endovascular) was 92.45%, 81.3%, and 70.0%, respectively. Conclusion: Endovascular treatment for thoracic aortic disease with the Talent stent graft is associated with low early morbidity and mortality rates also for patients who are at high risk and treated on an emergency basis. Follow-up data indicate a substantial durability of the procedure with a high freedom from related death and secondary interventions.
文摘Background: Penetrating aortic ulcer(PAU) is increasingly acknowledged as a pathological variant of classic false- lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of patients. The objective of this study was to investigate the results of endovascular stent- graft placement for the treatment of patients with PAUs. Methods: Between July 1999 and December 2004, endovascular stent- graft repair of PAU was performed in 22 patients(69.1± 7.8 years, 16 men), 3(14% ) of whom had contained aortic rupture. Stent- graft placement was performed in the cardiac catheterization laboratory with the patient under general anesthesia, using a surgical access. Results: Procedural success was achieved in all but 1 patient(technical success rate 96% ). Postoperatively, 1(5% ) patient had minor stroke with transient amentia. There were no other inhospital complications or deaths. During a median follow- up of 27(range 1- 62) months, 1 patient underwent adjunctive stent- graft placement for type I endoleak. Three patients died unrelated to the aortic disease late during follow- up. Overall survival rates were 100% at 30 days, 100% at 1 year, 82.5% ± 11.3% at 2 years, and 61.9% ± 20.0% at 5 years. Conclusions: Endovascular stent- graft treatment is an effective treatment for patients with PAU and is associated with low procedural morbidity. Both acute and midterm mortality of this novel treatment concept appear to be favorable compared with the natural course of the disease.
