tailieunhanh - An Internist’s Illustrated Guide to Gastrointestinal Surgery - part 9

Những trường hợp hiếm hoi, nhưng khó khăn cho đến khi gần đây một terra incognita cho endografts. Một loạt công bố gần đây của hai bệnh nhân cho thấy rằng endografting có thể không chỉ loại trừ chứng phình động mạch, nhưng ngăn chặn quá trình viêm | 274 Price HOSTILE ABDOMEN Patients with surgically hostile abdomens caused by radiation inflammatory bowel disease adhesions multiple surgeries or other conditions that would increase the difficulty of an open repair are good candidates for endografting. FEMALE PATIENTS Females generally are less likely to pass anatomic criteria for endografting usually because of smaller iliac arteries. However women who are successfully grafted probably do about as well as men 4 . INFLAMMATORY ANEURYSMS These rare but difficult cases were until recently a terra incognita for endografts. A recently published series of two patients suggest that endografting might not only exclude the aneurysm but stop the inflammatory process 5 . Given that the complication rate of conventional repair is considerable in inflammatory aneurysm it is reasonable to consign these patients to endografting when anatomically possible. YOUNG PATIENTS As of this writing the oldest implanted Ancure device of current design has been in place about 6 yr and the oldest implanted AneuRx device for less than that. In my opinion the current endografts should be considered to be of unknown and suspect durability for patients with long horizons and those patients should be guided toward conventional repair. GOOD OPERATIVE CANDIDATES These patients constitute by far the largest group of AAA patients. It is currently difficult to say which of them should be treated by which method decisions are currently driven by patient and physician choice. CONTRAINDICATIONS Inability to fit the AAA with a graft is by far the most common exclusionary factor for endografting. Mycotic AAA This should be treated with open excision and extraanatomic bypass in most cases because of the high likelihood of infection of an endograft. There have been a few reported cases of successful endografting of mycotic aneurysms in the thoracic aorta. Acutely Ruptured AAA Although there have been a few reported cases of successful endovascular repair .