Background The endovascular treatment of abdominal aortic aneurysm （AAA） has improved greatly in the last 15 years. The present study aimed to evaluate the endografting experience for the treatment of unfavorable ab...Background The endovascular treatment of abdominal aortic aneurysm （AAA） has improved greatly in the last 15 years. The present study aimed to evaluate the endografting experience for the treatment of unfavorable abdominal aortic aneurysm （uAAA）. Methods During December 2001 and December 2007, 41 patients with uAAA were treated with endografting using concomitant techniques. Patients were followed up for 1 to 48 months （mean 20.5 months）. Results Technical success rate was 97.6% （40/41） with 1 failure converted to open surgery for an unaccessed iliac stenosis. Nine （22.5%） type Ⅰ endoleaks （5 proximal and 4 distal） were observed on the completion angiograms and successfully corrected with aortic cuffs and iliac extensions during the procedure. Twenty-two of the planed adjunctive procedures were concomitantly performed just before endograft-implantation. There were 2 （5.0%） type Ⅰ endoleaks at 30 days; one type Ⅰ patient was treated by open conversion, another type Ⅰ patient died from a rupture before treatment in the ward, causing a 2.5% of initial mortality. The two type Ⅱ endoleaks were observed without aneurismal expansion. No buttock or leg claudication or ischemic colitis occured. During late follow-up, one additional death occurred from stroke. One new type Ⅰ endoleak was encountered from thrombocytopenia, which caused a 2.6% secondary endoleak that converted to an open surgery in the third month after a failed transabdominal banding of the aortic neck in the second month. All type Ⅱ endoleaks had disappeared in the third and sixth month. The Endografts did not present signs of material fatigue and no other type of endoleak formed. One patient presented with left limb ischemia, which underwent percutaneous transluminat angioplasty. There was no additional aneurysm rupture or any endograft imgration. Conclusion The endografting with concomitant procedures is a feasible and efficient alternative for managing unfavorable AAAs, achieving low morbidity and mortality rates and has a good clinical outcome.展开更多
Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm （TAAA） have recently been proposed as a less invasive alte...Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm （TAAA） have recently been proposed as a less invasive alternative to conventional TAAA surgery. This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients. Methods Between September 1998 and May 2012, 32 high-risk TAAA patients （five females, median age 61.5 years） underwent hybrid procedures at a single institution. Simultaneous approach and staged approach were performed on the basis of patients＇ conditions. Follow-up computed tomography angiography （CTA） was routinely performed before discharge and at 6, 12 months and annually thereafter. Results Procedural success was achieved in all cases. The median hospital stay was （21.5＋2.3） days, and the median procedure time was （420＋31） minutes. Blood loss averaged （2100_＋261） ml. A total of 124 visceral artery bypasses was performed. Two patients （6.3%） died within 30 days. One patient exhibited complete paraplegia （3.1%）. The visceral graft patency was 96.1% at 3 years. All-cause survival rates were 93.8%, 87.5%, 81.3% and 53.1% at 1, 2, 3 and 5 years, respectively. No patient died due to aortic events. The freedom rates from aortic events were 96.9%, 93.6%, 87.5%, 68.8% at 1,2, 3 and 5 years, respectively. Conclusions The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging. However, the procedure is still a significant physiological insult to patients. Until branched and fenestrated endovascular repair become more common, hybrid procedure will continue to have a role in high-risk patients.展开更多
文摘Background The endovascular treatment of abdominal aortic aneurysm （AAA） has improved greatly in the last 15 years. The present study aimed to evaluate the endografting experience for the treatment of unfavorable abdominal aortic aneurysm （uAAA）. Methods During December 2001 and December 2007, 41 patients with uAAA were treated with endografting using concomitant techniques. Patients were followed up for 1 to 48 months （mean 20.5 months）. Results Technical success rate was 97.6% （40/41） with 1 failure converted to open surgery for an unaccessed iliac stenosis. Nine （22.5%） type Ⅰ endoleaks （5 proximal and 4 distal） were observed on the completion angiograms and successfully corrected with aortic cuffs and iliac extensions during the procedure. Twenty-two of the planed adjunctive procedures were concomitantly performed just before endograft-implantation. There were 2 （5.0%） type Ⅰ endoleaks at 30 days; one type Ⅰ patient was treated by open conversion, another type Ⅰ patient died from a rupture before treatment in the ward, causing a 2.5% of initial mortality. The two type Ⅱ endoleaks were observed without aneurismal expansion. No buttock or leg claudication or ischemic colitis occured. During late follow-up, one additional death occurred from stroke. One new type Ⅰ endoleak was encountered from thrombocytopenia, which caused a 2.6% secondary endoleak that converted to an open surgery in the third month after a failed transabdominal banding of the aortic neck in the second month. All type Ⅱ endoleaks had disappeared in the third and sixth month. The Endografts did not present signs of material fatigue and no other type of endoleak formed. One patient presented with left limb ischemia, which underwent percutaneous transluminat angioplasty. There was no additional aneurysm rupture or any endograft imgration. Conclusion The endografting with concomitant procedures is a feasible and efficient alternative for managing unfavorable AAAs, achieving low morbidity and mortality rates and has a good clinical outcome.
文摘Background Hybrid procedures including debranching of visceral and renal arteries followed by endovascular exclusion of the thoracoabdominal aortic aneurysm （TAAA） have recently been proposed as a less invasive alternative to conventional TAAA surgery. This study aimed to evaluate the immediate and long-term outcomes of hybrid procedures for TAAA in high-risk patients. Methods Between September 1998 and May 2012, 32 high-risk TAAA patients （five females, median age 61.5 years） underwent hybrid procedures at a single institution. Simultaneous approach and staged approach were performed on the basis of patients＇ conditions. Follow-up computed tomography angiography （CTA） was routinely performed before discharge and at 6, 12 months and annually thereafter. Results Procedural success was achieved in all cases. The median hospital stay was （21.5＋2.3） days, and the median procedure time was （420＋31） minutes. Blood loss averaged （2100_＋261） ml. A total of 124 visceral artery bypasses was performed. Two patients （6.3%） died within 30 days. One patient exhibited complete paraplegia （3.1%）. The visceral graft patency was 96.1% at 3 years. All-cause survival rates were 93.8%, 87.5%, 81.3% and 53.1% at 1, 2, 3 and 5 years, respectively. No patient died due to aortic events. The freedom rates from aortic events were 96.9%, 93.6%, 87.5%, 68.8% at 1,2, 3 and 5 years, respectively. Conclusions The results of visceral hybrid repair for high-risk patients with complex TAAAs are encouraging. However, the procedure is still a significant physiological insult to patients. Until branched and fenestrated endovascular repair become more common, hybrid procedure will continue to have a role in high-risk patients.
