RESUMO
OBJECTIVE: To review the results of endovascular treatment of acute thoracic aortic diseases in a group of Chinese patients. DESIGN: Retrospective study. SETTING: A tertiary referral hospital with a cardiothoracic surgery service. PATIENTS: All 15 patients presenting with acute thoracic aortic diseases between September 2001 and October 2005 inclusive, of whom eight had traumatic rupture, four had complicated acute dissections, two had mycotic aneurysms, and one an aneurysm with an aortobronchial fistula. INTERVENTIONS: Thoracic aortic stent grafting. MAIN OUTCOME MEASURES: Immediate success, 6-month and 1-year survival rates. RESULTS: The median follow-up period was 20.6 months (range, 0-50.1 months). Stent grafts were deployed with immediate success in all patients. Two patients had ancillary bypass surgery for the supra-aortic branches. There were two in-hospital deaths. Four sustained access artery injury and needed graft repair. Computed tomography at 1 month showed complete thrombosis of the aneurysmal lumen or the thoracic aortic false lumen in 12 of 13 survivors. Computed tomography at 6 months showed complete thrombosis of the aneurysmal lumen or the false lumen in nine of 10 patients due for follow-up. Both 6-month and 1-year survival rates were 87%. CONCLUSIONS: Thoracic aortic stent grafting for acute thoracic aortic disease is feasible and has a high success rate, with good short-to-midterm results. However, the large size of the stent graft introducer set imposes a high risk of access artery injury, for which further improvements are necessary.
Assuntos
Aorta Torácica , Doenças da Aorta/terapia , Stents , Dissecção Aórtica/terapia , Aneurisma Infectado/terapia , Aorta Torácica/lesões , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , Ruptura Aórtica/terapia , Fístula Brônquica/terapia , Fístula/terapia , Seguimentos , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Initial presentation of a malignant disease as recurrent attacks of lower limb ischaemia due to emboli from a mural thrombus in the descending thoracic aorta is extremely rare. A diagnosis of malignancy may thus easily be overlooked. Recent advances in imaging technology have made the diagnosis of thoracic aortic mural thrombi much easier. Occult malignancy should always be suspected in the absence of biochemical evidence of hypercoagulability. We report on a patient with underlying malignant disease who presented with lower limb ischaemia that was relieved by axillobifemoral bypass.
