Sean Lyden教授   克利夫兰诊所

　　<International Circulation>: In comparison with surgery， what are the major advances of hybrid therapy?

　　Prof. Sean Lyden: In comparison with standard surgery， hybrid therapy really lowers the physiologic stress of the surgery on the patient. Although usually much more difficult on the surgeon， the time and recovery for the patient， the blood loss， the physiologic stress is clearly markedly reduced for the patient. This is opposed to treating aortic disease with open surgical therapy， there’s a laparotomy， generally 4 to 6 hours of surgery on the patient， and maybe anywhere between 4 days to a week in the hospital. With hybrid therapy， it’s still a 4 to 6 hour operation， but it’s done just through groin incisions， so there’s still a lot less blood loss， a lot less change in temperature. The patient is typically able to go home the next day. So patients really recover much quicker.

　　《国际循环》：和外科手术治疗相比，复合技术治疗主-髂动脉闭塞疾病的优势表现在哪些方面？

　　Sean Lyden教授：与标准手术治疗相比，复合技术能降低手术对患者所造成的生理压力。虽然复合技术难度更大，但却能显著减少患者的手术及恢复时间、失血量及生理性应激。采用开放性手术疗法治疗主动脉疾病时，一般采用开腹手术，手术通常历时4~6小时，患者一般需住院4天至1周。但是，采用复合技术，虽然手术时间仍需要4~6小时，但却可通过腹股沟切口进行手术，故而失血量较少、温度变化较小。患者第2天即可出院，恢复更快。

　　<International Circulation>: How are the long-term patency rate and outcome of the hybrid therapy?

　　Prof. Sean Lyden: When we first started doing it， we were met with a lot of skepticism of how well it would work. As with any therapy， when you first start doing it， you’re very enthusiastic. But one of the concerns is always the long-term durability. When we first started looking at outcomes with hybrid therapy for aortic disease， we found that through three years， the chance of keeping that therapy open is equivalent to open surgery. When we first looked at results， our prior chairman， who did a lot of pioneering work with the risk of myocardial ischemia when you’re having vascular surgery， really challenged us to ask， “Is this as good as open surgery?” So then we really went back and looked at our cases compared with patients with open surgery， finding that with the results for three years were equivalent. Now with open surgical therapy， we’ve got decades and decades of experience and we’re hoping that it continues to be as successful through years 5 through 10， and that data is still forthcoming.

　　《国际循环》：主-髂动脉闭塞采用复合技术治疗的远期通畅率和预后情况如何？

　　Sean Lyden教授：我们刚开展该技术时对其疗效也存在很多质疑。对任何一种治疗方法，我们一开始应用时都热情百倍。但问题是长期疗效如何？但我们刚开始研究复合技术对主动脉疾病结局的影响时发现，其3年内的疗效与开放性手术相当。当大家都在开展血管外科的时候，我们的前主席做了大量降低血管手术心肌缺血风险的开创性工作——复合技术。为确定“这种疗法是否和开放性手术一样好？”，我们对我们的患者与行开放性手术的患者进行回顾性分析，结果发现，3年内二者的结局相当。开放手术治疗历经几十年发展，我们拥有几十年的应用经验。我们希望经过5~10年后，其还能一样成功，相关数据仍有待公布。

　　<International Circulation>: In recent years， what progress has been made on devices regarding aortic interventional therapy?

　　Prof. Sean Lyden: In aortic interventional therapy， we’ve seen a huge growth in what we have available to us. Starting in the late 90s， were really the first generation therapies. In the United States in 1999， the first aortic stent grafts were approved and we’ve seen a lot of development. Outside of the United States， we’ve seen faster growth because of the less restrictive agencies in Europe as compared to the FDA. And now， we’re really starting to see it both in the United States and other parts of the world. The original devices all had very similar indications of what they could treat in terms of the length of the aorta， the size of the blood vessel you could have， and recently we’ve seen the approval of devices to treat anatomy that comes closer to the kidney arteries， than development of devices that could really treat from the arch of the aorta all the way down to the groin. We’ve seen devices now with stapling technology to help hold it in place， as well as really looking outside the box to develop therapies to lower the profiles to treat women. The vast majority of aneurisms in the abdominal aorta happen in men. But endovascular minimally invasive therapy really has not been quite as applicable to women because of their smaller vessels and an inability to get these vessels in the patient. Over the last several years we’ve seen the introduction of lower profile devices that really have broadened that ability to offer this therapy to women.

　　《国际循环》：近年来，主动脉介入器械方面取得了哪些进展？

　　Sean Lyden教授：主动脉介入治疗取得了重大进步。20世纪90年代末，第一代治疗设备问世。1999年美国正式批准第一个主动脉支架人工血管上市，随后该领域得到了很大的发展。与美国FDA相比，欧洲监管结构对其限制更少，故其发展更为迅速。现在，在美国及世界其他地区，主动脉介入治疗设备都得到了广泛应用。最初所有设备的治疗适应证（对主动脉长度、血管直径的要求）均非常相似，而现在可放置在接近肾动脉解剖部位的设备已经获批，设备的不断发展有望使我们能够治疗从主动脉弓到腹股沟区域的所有病变。新的对吻挤压技术有助于设备的固定，治疗女性患者的相关低剖面设备也在积极研发中。腹主动脉瘤绝大多数发生于男性。女性患者的血管通常更细小，设备难以放入，故血管内微创疗法在女性中应用相对较少。过去几十年间，我们研发了低剖面设备，提高了为女性患者提供该疗法的能力。