Thoracic aortic lesions treated with the Zenith TX1 and TX2 thoracic devices: Intermediate- and long-term outcomes

被引:41
作者
Morales, Jose P. [1 ]
Greenberg, Roy K. [1 ,2 ]
Morales, Catherine A. [1 ]
Cury, Marcelo [1 ]
Hernandez, Adrian V. [3 ]
Lyden, Sean P. [1 ]
Clair, Daniel [1 ]
机构
[1] Cleveland Clin, Dept Vasc & Endovasc Surg, Cleveland, OH 44195 USA
[2] Cleveland Clin, Dept Thorac & Cardiovasc Surg, Cleveland, OH 44195 USA
[3] Cleveland Clin, Dept Quantit Hlth Sci, Cleveland, OH 44195 USA
关键词
D O I
10.1016/j.jvs.2008.02.028
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Little data exist to support the durability of thoracic endovascular repair during prolonged periods of follow-up. This study examines the durability and long-term results with the Zenith TX1 and TX2 thoracic devices (Cook Inc, Bloomington, Ind) in high-risk patients. Methods. Data were collected prospectively from 2001 to 2007 on high-risk patients who presented with thoracic aneurysms, chronic aortic dissection, or fistulas treated with a Zenith thoracic device. Surgical modifications of proximal or distal landing zones were performed when necessary. Computed tomography follow-up scans were performed before discharge, at 1, 6, and 12 months, and yearly thereafter. Three-dimensional reconstruction software with central line of flow measurements was used to assess aortic morphologic characteristics. Kaplan-Meier analysis was used to assess survival, freedom from reintervention, predictive factors of poor outcome, and morphologic changes, including aneurysm sac behavior. Results. A total of 160 patients (44% women; mean age, 70) were treated for 130 thoracic aneurysms, 25 aortic dissections with aneurysm, 2 fistulas, and 3 symptomatic or aortic ruptures, or both. Mean follow-up was 36 months, and aneurysm size was 67 nun. Seventy-five patients (47%) had undergone prior aortic aneurysm repair. Surgical modifications were required to create adequate landing zones in 33% patients, including 28 elephant trunk/arch reconstruction, 22 carotid-subclavian bypasses, and seven visceral vessel bypasses. Iliac conduits were required in 31 patients. Early mortality (< 30 days) occurred in 11 patients (6.9%). Overall mortality at 1 year was 16%. Aneurysm sac increase (> 5 mm) requiring intervention was observed only in one patient in the settings of component separation and type III endoleak that was treated; the sac is now stable. Twenty-seven endoleaks were detected in 25 patients: 15 primary endoleaks (9.4%) <30 days and 12 secondary endoleaks (7.5%) >30 days. Secondary interventions were required in 42 patients (26%). Conclusion: Endovascular treatment of thoracic aortic pathologies with the Zenith TX1 and TX2 devices is feasible and durable. The mid- to long-term results are encouraging, with acceptable low reintervention rates and with good survival within high-risk patients.
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页码:54 / 63
页数:10
相关论文
共 32 条
  • [1] Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: A multicenter comparative trial
    Bavaria, Joseph E.
    Appoo, Jehangir J.
    Makaroun, Michel S.
    Verter, Joel
    Yu, Zi-Fan
    Mitchell, R. Scott
    [J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2007, 133 (02) : 369 - U17
  • [2] Mid-term results for second-generation thoracic stent grafts
    Bell, RE
    Taylor, PR
    Aukett, M
    Sabharwal, T
    Reidy, JF
    [J]. BRITISH JOURNAL OF SURGERY, 2003, 90 (07) : 811 - 817
  • [3] OUTCOME AND EXPANSION RATE OF 57 THORACOABDOMINAL AORTIC-ANEURYSMS MANAGED NONOPERATIVELY
    CAMBRIA, RA
    GLOVICZKI, P
    STANSON, AW
    CHERRY, KJ
    BOWER, TC
    HALLETT, JW
    PAIROLERO, PC
    [J]. AMERICAN JOURNAL OF SURGERY, 1995, 170 (02) : 213 - 217
  • [4] Thoracoabdominal aneurysm repair: Results with 337 operations performed over a 15-year interval
    Cambria, RP
    Clouse, WD
    Davison, JK
    Dunn, PF
    Corey, M
    Dorer, D
    [J]. ANNALS OF SURGERY, 2002, 236 (04) : 471 - 479
  • [5] Improved prognosis of thoracic aortic aneurysms - A population-based study
    Clouse, WD
    Hallett, JW
    Schaff, HV
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 280 (22): : 1926 - 1929
  • [6] COOLEY DA, 1955, J THORAC SURG, V29, P66
  • [7] Left heart bypass during descending thoracic aortic aneurysm repair does not reduce the incidence of paraplegia
    Coselli, JS
    LeMaire, SA
    Conklin, LD
    Adams, GJ
    [J]. ANNALS OF THORACIC SURGERY, 2004, 77 (04) : 1298 - 1303
  • [8] CRAWFORD ES, 1981, SURGERY, V89, P73
  • [9] Czerny M, 2004, J ENDOVASC THER, V11, P26, DOI 10.1583/1545-1550(2004)011<0026:SPIADT>2.0.CO
  • [10] 2