演題

IS-1-4

Urgent thoracic endovascular aortic repair for acute aortic disease

[演者] 佐賀 俊文:1
[著者] 森下 清文:1, 馬場 俊雄:1, 柴田 豪:1, 楢山 耕平:1, 馬渡 徹:2
1:市立函館病院心臓血管外科, 2:市立函館病院呼吸器外科

Objectives: Acute aortic disease confers a significantly increased risk of adverse outcome and death. Endovascular treatment for such critically ill patients is expected to decrease mortality and morbidity. The aim of this study was to evaluate the effect of emergency thoracic endovascular aortic repair (TEVAR) on mid-term survival and outcome.Methods: From December 2007 to July 2014, 33 patients (58% men; averaged age, 74 years) underwent TEVAR for acute aortic pathology. Operative indications were ruptured aortic aneurysm in 20 patients, traumatic aortic injury in 8, ruptured anastomotic aneurysm in 3, and idiopathic aortic rupture in 2.The mean Japan score was 39%+/-22%. Six patients suffered from shock. Associated procedures included total debranching in 3 patients.Results:The 30-day mortality was 15% (5 of 33). The cause of death in 4 patients was multiple organ failure. One patient who had re-rupture during balloon molding of the endograft died of massive exsanguination. Postoperative complications included 17 respiratory failure requiring prolonged mechanical ventilation, 3 strokes, and 3 renal failure necessitating dialysis. Endgraft-related complications were access trouble in 3 patients, endoleak in 4 patients, and graft migration in 1 patient. Of the 5 patients with endoleak or graft migration, two patients underwent re TEVAR during follow-up. There were 7 late deaths. Aneurysm-related death occurred in 2 patients among them. Kaplan-Meier survival was 59%+/-10% at 1 year and 55%+/-10% at 4 years.Conclusions: Early and midterm outcomes of emergencyTEVAR for acute aortic disease are good . However, long-term surveillance will be needed because of late aortic events.
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