目的:本研究的目的是描述因原发性或复发性主动脉缩窄而接受胸部支架置入治疗的成年患者的结局。
方法:这是一项回顾性研究,对我们机构的30例因主动脉缩窄而接受胸部支架置入术的成年患者进行了回顾性研究。平均年龄为46.5岁,53.3%的患者没有接受过缩窄治疗或修复。修复的适应症包括梯度≥20mmHg,在左心室肥大的影像学上有缩窄的解剖证据,假性动脉瘤,动脉瘤,难治性高血压,或者跛行.用于修复的支架移植物包括MDT(Medtronic,圣罗莎,CA)和GORE标签(W.L.Gore&Associates,弗拉格斯塔夫,AZ).
结果:患者的平均观察时间为979天,研究期间有一人死亡。所有患者症状完全缓解,无复发。TEVAR显著降低了跨缩窄的梯度(p<0.0001)。主动脉缩窄直径在术后30天显着增加,并在治疗后持续增加至5年。3年以上,在缩窄部位和周围区域观察到主动脉重塑。在30天,收缩压,舒张压,平均动脉压均降低。治疗后1年,收缩压和舒张压以及MAP继续显着改善。
结论:支架移植是治疗主动脉缩窄的一种安全有效的方法。我们观察到血压的临床显着改善,缩窄段和整个主动脉的纵向主动脉重塑持续超过3年。
BACKGROUND: This study\'s objective is to describe outcomes of adult patients who underwent thoracic stent graft placement treatment for primary or recurrent aortic
coarctation.
METHODS: This is a retrospective study of 30 adult patients who underwent thoracic stent graft placement for aortic coarctation at our institution. Average age was 46.5 years, with 53.3% of patients presented with no prior treatment or repair for coarctation. Indications for repair included gradient ≥20 mm Hg with anatomic evidence of
coarctation on imaging with left ventricular hypertrophy, pseudoaneurysm, aneurysm, refractory hypertension, or claudication. Stent grafts used for repair included MDT (Medtronic, Santa Rosa, CA) and GORE TAG (W. L. Gore & Associates, Flagstaff, AZ).
RESULTS: Patients were observed for a median of 979 days, with one death during the study. All patients had complete resolution of symptoms with no recurrences. Thoracic endovascular aortic repair significantly reduced the gradient across the coarctation (P < 0.0001). Aortic
coarctation diameter significantly increased at 30 days postoperatively and continued to increase up to 5 years posttreatment. At 3+ years, aortic remodeling was observed at the
coarctation site and surrounding regions. At 30 days, systolic, diastolic, and mean arterial pressure were all reduced. Systolic and diastolic blood pressure and mean arterial pressure continued to significantly improve 1-year posttreatment.
CONCLUSIONS: Stent grafts are a safe and effective treatment for aortic
coarctation. We observed a clinically significant improvement in blood pressure and longitudinal aortic remodeling of the coarctation segment and the entire aorta that persisted more than more than 3 years.