Stent-Grafts cho Phình Động Mạch Chủ Bụng Không Vỡ: Tình Trạng Hiện Tại

Springer Science and Business Media LLC - Tập 29 - Trang 332-343 - 2006
John Rose1
1Department of Interventional Radiology, Freeman Hospital, UK

Tóm tắt

Stent-grafts động mạch chủ được giới thiệu vào đầu thập niên 1990 như một phương pháp ít xâm lấn hơn trong việc xử lý các phình động mạch chủ ở những bệnh nhân có khả năng dự trữ tim mạch kém. Số lượng các thủ thuật được thực hiện trên toàn thế giới đã tăng lên một cách đáng kể mặc dù hiện tại vẫn chưa có bằng chứng nào đáng kể về hiệu quả lâu dài so với tiêu chuẩn vàng của phẫu thuật mạch ghép mở. Bài tổng quan này tóm tắt sự tiến hóa của stent-grafts động mạch chủ bụng, các kỹ thuật được sử dụng để đánh giá và triển khai, cũng như tác động của thủ thuật đối với cả bệnh nhân và thiết bị. Việc công bố gần đây của hai thử nghiệm đa trung tâm quốc gia đã xác nhận rằng kỹ thuật nội mạch giảm 2,5 lần tỷ lệ tử vong trong 30 ngày so với phẫu thuật mở. Tuy nhiên, sau 4 năm theo dõi, có sự gia tăng gấp 3 lần nguy cơ can thiệp lại, và tổng chi phí cao hơn 30% với sửa chữa nội mạch. Mặc dù cải thiện về tỷ lệ tử vong liên quan đến phình động mạch vẫn tồn tại trong trung hạn, nhờ vào việc giảm tử vong trong perioperative ban đầu, tỷ lệ tử vong do tất cả các nguyên nhân sau 4 năm thực tế không tốt hơn so với phẫu thuật mở. Dữ liệu lâu dài từ các thử nghiệm ngẫu nhiên đang được chờ đợi cùng với kết quả từ các thử nghiệm mới nhất sử dụng các thiết bị hiện đại. Mặc dù việc quản lý tổng thể các phình động mạch chủ bụng chắc chắn đã hưởng lợi từ sự ra đời của stent-grafts, sửa chữa mở hiện vẫn là phương pháp điều trị tiêu chuẩn vàng.

Từ khóa

#stent-grafts #động mạch chủ bụng #phình động mạch #phẫu thuật mạch ghép #kỹ thuật nội mạch

Tài liệu tham khảo

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