■A型主动脉夹层的初始手术有局限性,在巨大假性动脉瘤形成和远端血管供血减少的情况下,可能需要再次手术。在这项研究中,我们收集在我院接受心脏大血管手术患者的病例资料,分析A型主动脉夹层再手术治疗方案的有效性,并总结我们的治疗经验.
■在2018年6月至2022年12月之间,62例A型主动脉夹层(TAAD)患者在先前的手术治疗后接受了再次手术。其中,49例(男45例)行主动脉腔内修复术(EVAR),平均年龄(49.69±10.21)岁(30~75岁),13例患者(11例男性)接受了胸腹主动脉置换术(TAAR),平均年龄为(41.00±11.18)岁(23-66岁)。在这项研究中,我们对62例患者的记录资料进行回顾性分析.此外,我们总结并分析了他们的CT血管造影(CTA)结果和围手术期并发症。
■在EVAR组中,47例患者(95.92%)成功植入重叠支架,围手术期死亡2例。术后并发症包括脑梗死(4.08%),急性肾功能不全(30.61%),肺功能不全和需要呼吸机(6.12%),伤口愈合不良(2.04%),术后再次手术(16.33%),下肢缺血(2.04%)。在TAAR组中,12例(92.31%)成功实施血运重建,1例死亡。术后并发症包括脑梗死(7.69%),急性肾损伤(46.15%),肺功能不全和需要呼吸机(15.38%),伤口愈合不良(30.77%)和术后再次手术(15.38%)。
■根据研究结果,与TAAR相比,EVAR侵入性较小,更快的恢复,并为一些高风险和高年龄合并基础疾病的患者提供了更好的选择。然而,由于血管病变,EVAR后血运重建率高于TAAR.与许多国家和地区采用升主动脉置换术+半主动脉弓置换术治疗急性A型主动脉夹层相比,在中国,使用升主动脉置换术+主动脉弓置换术+象鼻支架的创伤更大,但有利于再次手术。对于年轻患者来说,治疗应结合血管病变和长期生活质量进行个体化选择。
UNASSIGNED: The initial operation for type A aortic dissection has limitations, and there may be a need for reoperation in cases such as giant pseudoaneurysm formation and reduced blood supply to the distal vessels. In this
study, we collected case data of patients who underwent cardiac major vascular surgery at our hospital to analyze the effectiveness of reoperation treatment options for type A aortic dissection and to summarize our treatment experience.
UNASSIGNED: Between June 2018 and December 2022, 62 patients with type A aortic dissection (TAAD) underwent reoperation after previous surgical treatment. Of these, 49 patients (45 males) underwent endovascular aortic repair (EVAR) with a mean age of (49.69 ± 10.21) years (30-75 years), and 13 patients (11 males) underwent thoracoabdominal aortic replacement (TAAR) with a mean age of (41.00 ± 11.18) years (23-66 years). In this
study, we retrospectively analyzed the recorded data of 62 patients. In addition, we summarized and analyzed their Computed Tomographic Angiography (CTA) results and perioperative complications.
UNASSIGNED: In the EVAR group, 47 patients (95.92%) were successfully implanted with overlapping stents, and 2 patients died in the perioperative period. Postoperative complications included cerebral infarction (4.08%), acute renal insufficiency (30.61%), pulmonary insufficiency and need for ventilator (6.12%), poor wound healing (2.04%), postoperative reoperation (16.33%), and lower limb ischemia (2.04%). In the TAAR group, 12 patients (92.31%) were successfully revascularized and 1 patient died in the perioperative period. Postoperative complications included cerebral infarction (7.69%), acute kidney injury (46.15%), pulmonary insufficiency and need for ventilator (15.38%), poor wound healing (30.77%) and postoperative reoperation (15.38%).
UNASSIGNED: According to the results of the
study, compared with TAAR, EVAR was less invasive, faster recovery, and offered a better choice for some high-risk and high-age patients with comorbid underlying diseases. However, the rate of revascularization was higher after EVAR than TAAR due to vascular lesions. Compared with the use of ascending aortic replacement + hemi-aortic arch replacement for acute type A aortic dissection in many countries and regions, the use of ascending aortic replacement + aortic arch replacement + elephant trunk stent is more traumatic in China, but facilitates reoperation. For young patients, the choice of treatment should be individualized combining vascular lesions and long-term quality of life.