可调式单分支覆膜支架血管在Stanford A型主动脉夹层手术应用的远期疗效

目的探讨Stanford A型主动脉夹层外科手术中使用可调式单分支覆膜支架血管的可行性及远期疗效。方法将2014年8月到2015年4月广东省人民医院心外科收治的Stanford A型主动脉夹层患者按照知情同意,入选、排除标准原则,抽签决定主动脉弓部处理方法,分为应用可调式单分支覆膜支架(A)组和应用常规支架血管(B)组,分别行升主动脉/bentall+全主动脉弓置换+支架象鼻支架手术。结果入组患者共27例,A组18例和B组9例,两组病死率比较,差异无统计学意义(A组死亡1例,B组死亡2例,P0.05)。两组年龄、体质量、手术时机、体外循环时间、阻断时间、手术时间、手术出血量、手术后24 h引流量、重症监护病房停留时间、呼吸机时间和并发症发生率等比较,差异均无统计学意义(P0.05)。结论可调式单分支覆膜支架简化手术步骤,降低手术难度的同时,达到了与常规手术治疗Stanford A型主动脉夹层相近的临床疗效,单分支覆膜支架可用于主动脉支架象鼻手术治疗主动脉A型夹层。     

比较孙氏手术与去分支化杂交手术治疗急性Ⅰ型主动脉夹层的疗效

目的:比较接受孙氏手术与去分支化杂交手术治疗的急性Ⅰ型主动脉夹层患者的围术期及术后短期预后。方法:纳入2015年3月至2017年5月在兰州大学第一医院心血管外科行Ⅰ型主动脉夹层广泛修复手术患者85例,其中行孙氏手术患者(孙氏组)64例,行去分支化杂交手术患者(去分支化组)21例,比较两组患者围术期及术后短期生存状况。结果:与孙氏组相比,去分支化组患者年龄大,肥胖、术前合并肝功不全者比例高,主动脉阻断及体外循环时间短,术后呼吸机辅助呼吸时间短,围术期红细胞及冷沉淀使用量少,ICU住院时间及术后住院时间短,肺部感染率低(P均0.05)。两组的在院死亡率和术后1年生存率无统计学差异。结论:去分支化杂交手术是治疗急性Ⅰ型主动脉夹层的新方法,适用于高龄、高危人群,短期预后良好。     

应用孙氏手术对Standford A型主动脉夹层的治疗体会

目的:评价应用全主动脉弓人工血管替换加改良支架象鼻技术(孙氏手术),治疗Standford A型主动脉夹层的临床效果。方法:自2012年6月至2013年6月,应用孙氏手术治疗急性Standford A型主动脉夹层11例,男性9例,女性2例,平均(42.1±10.4)岁。同期升主动脉行单纯置换8例,Bentall手术1例,Mini-root手术2例。结果:全组平均体外循环(166.0±44.8)min,主动脉阻断(103.7±17.5)min,深低温停循环(55.1±11.3)min,肾衰竭需要接受长期血液透析治疗1例,术后院内无死亡病例;平均随访(5.6±2.0)个月,随访中无死亡病例,患者出院1个月后支架血管段假腔闭合效果好的占81.8%。结论:应用孙氏手术治疗主动脉夹层有良好的临床效果。     

一站式杂交手术治疗急性Stanford A型主动脉夹层

目的:总结一站式杂交手术治疗Stanford A型主动脉夹层的手术方法及早期治疗效果。方法:对15例急性Standford A型主动脉夹层患者采用一站式杂交手术,即升主动脉及弓上分支血管人工血管置换联合主动脉腔内修复手术,观察其手术时间、术后麻醉清醒时间、出血量、呼吸机辅助时间等指标。结果:15例患者均顺利完成手术,1例患者术后死于肺部感染。全组病例中体外循环时间为82~136min,主动脉阻断时间为30~65min。术后在监护病房中,有12例患者在6h内清醒。11例患者在术后48h之间拔出气管插管。术后首个24h引流量在325~575ml。术后两周和3个月左右复查主动脉CTA提示,人工血管形态良好,分支血管血流通畅,支架血管无移位。夹层近端破口封闭良好,无造影剂渗漏,支架附近假腔完全血栓化。结论:一站式杂交手术治疗Stanford A型主动脉夹层,避免深低温停循环,缩短手术时间,减少手术创伤,降低了手术后并发症的发生率,在近期能表现出很好的治疗效果。但由于其覆膜支架材料的限制,其远期效果尚不明确,还需要进一步随访总结。     

孙氏手术与联合三分支支架血管术中置入治疗急性Stanford A型主动脉夹层对比

目的 探讨孙氏手术、联合三分支支架血管术中置入两手术方式治疗急性Stanford A型主动脉夹层的疗效.方法 2011年1月至2013年1月我院收治的急性Stanford A型主动脉夹层患者,以孙立忠教授主动脉细化分型中AC型为入选标准,选取患者24例.孙氏手术组患者12例,单纯行升主动脉及全弓替换加支架“象鼻”手术9例,同期主动脉根部替换手术（Bentall术）2例,主动脉瓣成形1例.联合三分支支架血管术中置入组患者12例,单纯三分支支架术中置入3例,同期升主动脉替换8例,主动脉根部替换手术（Bentall术）1例.出院前、术后3个月、术后每年复查主动脉全程重建CT.结果 孙氏手术组：平均手术时间（10.00±1.60）h,平均体外循环时间（253.33±49.33）min,平均心肌阻断时间（141.41±27.58）min,选择性脑灌注时间（39.67±10.28）min.住院死亡4例,死亡原因：多脏器衰竭2例,术后肾功能衰竭1例,术后呼吸功能衰竭1例.联合三分支支架血管术中置入组：平均手术时间（7.77±2.06）h,平均体外循环时间（168.25±32.05）min,平均心肌阻断时间（79.75±29.54）min,选择性脑灌注时间（24.33±6.53）min.住院死亡2例,死亡原因：术后呼吸功能衰竭死亡1例,1例术后一直未醒,术后第5天少尿,家属放弃治疗.孙氏手术组随访（11.09±6.87）个月,无死亡及需再次手术者.联合三分支支架术中置入组随访（18.40±8.03）个月,术后死亡2例,1例术后1年胸痛发作,心脏彩超提示升主动脉明显增宽,主动脉后壁分离为两层,当即死亡;1例术后2年随访主动脉全程重建CT提示无名动脉近端内漏.结论 孙氏手术和联合三分支支架血管术中置入术是治疗大多数急性Stanford A型主动脉夹层安全有效的方法.作为一种崭新的技术手段,联合三分支支架血管术中置入简化了手术步骤,术后内漏是高危因素,对该种手术方式患者选取应有一定针对性,根据患者信息订制更加个体化支架,并且需要长期随访.     

急性Stanford A型主动脉夹层再手术治疗分析

摘要 目的：探讨急性A型主动脉夹层再手术治疗的效果,总结其外科治疗经验。方法 ：回顾分析2007年1月-2017年5月16例Stanford A型主动脉夹层再手术患者的临床资料。首次手术包括升主动脉替换术1例,Wheat手术 (升主动脉+主动脉瓣替换术)1例,升主动脉+次全弓替换+主动脉瓣成形术1例,升主动脉替换+孙氏手术（全弓替换及降主动脉支架象鼻人工血管置入）2例,升主动脉替换+孙氏手术+主动脉窦部成形术4例,Bentall手术(带瓣人工血管升主动脉替换替换术)3例,Bentall+孙氏手术4例。再次手术方式包括孙氏手术5例,全主动脉置换术1例,全胸腹主动脉替换2例,主动脉瓣周漏修补术1例,主动脉根部吻合口漏修补术2例（其中1例并行主动脉根部假性动脉瘤切除术）,主动脉覆膜支架腔内隔绝术7例。结果：1例患者在围术期死亡,术后并发症共8例。其中再次开胸2例,伤口感染2例,低心排综合症1例,神经系统并发症1例,肺部感染2例,以上并发症均于出院前治愈。结论：急性A型主动脉夹层再手术临床效果满意,因弓部病变再次行孙氏手术亦安全、有效;孙氏术后远端主动脉病变行常温非体外循环下全胸腹主动脉替换术亦是一种安全、有效的外科策略。     

Stanford A型夹层动脉瘤112例手术治疗体会

目的 提高Stanford A型夹层动脉瘤的治疗水平.方法 对112例Stanford A型夹层动脉瘤患者根据升主动脉受累部位分别采用直接升主动脉人造血管置换或David、Bentall 、Carbrol、 Wheat手术,主动脉弓部受累者置入带分支人工血管,胸降主动脉受累者同时行"象鼻"或"支架象鼻"手术.结果 110例手术顺利,术中出血200～1 600 ml,共植入人工血管123条;术中死亡2例.术后出现并发症22例,死亡3例.本组康复出院107例,术后2 a内复查无移植物感染、栓塞狭窄,均能行轻度体力劳动,心功能Ⅰ级85例,Ⅱ级22例.结论 手术是治疗Stanford A型夹层动脉瘤首选治疗方法,应根据累及部位选择不同术式,预防术中出血、缩短体外循环时间是手术成功的关键.     

传统及改良孙氏手术在急性Stanford A型主动脉夹层的应用

目的 探讨急性Stanford A型主动脉夹层外科治疗应用孙氏手术（主动脉全弓置换+象鼻支架手术）的效果,总结手术经验。方法 回顾性分析2017年09月至2018年06月间收治的急性Stanford A型主动脉夹层17例行孙氏手术治疗的临床资料（均为男性; 年龄为54.5±8.8岁）,统计分析患者手术、术后及随访资料。结果 患者行传统孙氏手术13例,改良孙氏手术（保留头臂动脉的孙氏手术）4例。全组体外循环时间(176.7±25.6)min,主动脉阻断时间(96.6±30.1)min,停循环时间(19.4±3.9)min, 辅助时间(74.2±20.7)min。治愈患者12例,术后30天内患者死亡5例,治愈患者随访2-10个月,均无再次手术,心功能Ⅰ级11例,1例为心功能Ⅱ级。结论 传统以及改良的孙氏手术治疗急性Stanford A型主动脉夹层近中期效果确切,远期疗效有待于进一步监测与随访。     

升主动脉替换联合三分支支架血管术中植入治疗急性A型主动脉夹层

目的报道升主动脉人造血管替换联合三分支支架血管术中植入治疗急性Stanford A型主动脉夹层的初步经验。方法 2008年6月至2009年9月20例急性A型主动脉夹层患者接受了升主动脉人造血管替换和三分支支架血管植入术。当体外循环鼻咽温度降至20℃时,停止下半身灌注,经无名动脉近端升主动脉横断切口,将三分支支架血管植入主动脉弓和近端胸降主动脉真腔内,并将其分支支架血管依次植入左锁骨下动脉、左颈总动脉和无名动脉。将主干支架血管的近端与无名动脉近端的升主动脉切口重建后与替换近端升主动脉的人造血管端端吻合。结果所有患者术中均顺利地植入三分支支架血管,平均体外循环时间(163.2±19.21)min、心肌阻断时间(89.4±10.02)min、低流量选择性脑灌注和下半身缺血时间为(32.7±6.63)min。术后出现短暂性神智障碍1例,急性肾功能衰竭1例。20例患者均痊愈出院。术后3个月电子束CT检查结果示:主干支架血管及分支支架血管通畅、无扭曲;支架血管植入部位夹层假腔闭合;16例患者远端胸降主动脉夹层假腔闭合。结论三分支支架血管术中植入是简化急性主动脉夹层患者主动脉弓重建、提高手术安全性的一种有效新方法。主要适应证为弓内内膜无破口而需主动脉弓重建的急性A型主动脉夹层患者。支架血管大小、分支支架血管间的距离的选择和放置过程中避免内膜损伤时术中三分支支架血管成功放置的关键。     

急性A型主动脉夹层孙氏术后低氧血症的相关因素分析

目的:探讨急性A型主动脉夹层孙氏术后低氧血症发生的相关危险因素。方法:回顾性分析首都医科大学附属北京安贞医院,2018年1月至2018年12月,连续收治的209例急性A型主动脉夹层行孙氏手术患者的临床资料。男性172例,女性37例;平均年龄(47.4±10.1)岁;发病到手术时间14 d。根据术后是否发生低氧血症,将209例患者分为低氧血症组[PaO_2/吸入氧浓度(FiO_2)200 mmHg, 1 mmHg=0.133 kPa]和非低氧血症组(PaO_2/FiO_2≥200 mmHg)。分析和比较两组患者的围术期相关资料,采用多因素Logistic回归分析急性主动脉夹层患者术后发生低氧血症的危险因素。结果:术后低氧血症的发生率56.9%(119/209),围术期死亡20例(9.6%,其中低氧血症组13例,非低氧血症组7例)。单因素分析结果:两组患者发病到手术时间(h)、发病到手术时间24 h、术前ALT、Cr、BMI差异有统计学意义(P0.05);低氧血症组呼吸机辅助通气时间、重症监护病房(ICU)滞留时间多于非低氧血症组,差异有统计学意义(P0.05)。多因素回归分析结果显示:BMI、发病到手术时间24 h是急性A型主动脉夹层孙氏术后低氧血症的危险因素。结论:低氧血症是急性A型主动脉夹层孙氏术后常见的并发症,肥胖、发病到手术时间24 h是急性A型主动脉夹层孙氏术后低氧血症的危险因素,针对性地给予干预措施,以降低低氧血症发生率,从而改善患者的预后。     

带膜内支架治疗胸主动脉瘤

目的 探寻治疗胸主动脉瘤的新术式。方法 10例胸主动脉瘤病例，其中7例行单纯带膜血管内支架(stent-graft)治疗，3例夹层破裂(De Bakey I)患者行象鼻手术加带膜血管内支架置入术。结果 7例带膜血管内支架治疗组，5例成功，1例失败，1例术后死亡；3例夹层破裂手术病例均成功，恢复顺利，无并发症。结论带膜血管内支架为治疗胸降主动脉瘤的一种有效可靠方法；象鼻手术结合带膜内支架是治疗De BakeyI型的新方式，可降低手术并发症及术后病死率。     

Transfemoral stent-graft placement to treat a complication of the frozen elephant trunk procedure.

PURPOSE: To report a novel complication of a hybrid "frozen elephant trunk" endograft used in the treatment of a multisegmentally diseased aorta. CASE REPORT: A 53-year-old man with chronic type A aortic dissection and previous replacement of the supracoronary ascending aorta underwent a "frozen elephant trunk" procedure using a hybrid endograft. The stent-graft was placed deep in the descending aorta to cover the multiple distal re-entries. Due to ineffective covering of the re-entries, a patent false lumen led to rapid repressurization of the false lumen immediately distal to the circumferential elephant trunk anastomosis. Compression of the non-stented portion of the hybrid endograft caused a functional aortic stenosis, with severe hemodynamic consequences. Endovascular treatment of the compression by retrograde transfemoral placement of a stent-graft in the non-stented portion of the hybrid endograft achieved free flow in the distal aorta. CONCLUSION: This case documents a new complication of the frozen elephant trunk procedure; a pseudocoarctation from a repressurized proximal false lumen was successfully managed with a stent-graft to support the non-stented segment of the hybrid endograft.     

Scope-guided implantation of a stented elephant trunk in acute aortic dissection.

A reliable guide is essential for implanting a stented graft safely into a recently dissected, fragile aorta. In 4 patients with acute aortic dissection, the implantation of a stented elephant trunk was done safely using an endoscope for direct visualization. In all patients, the operation went well. The placement of a stent appears to enhance the benefit of the elephant trunk, which itself reduces the complications of an arch replacement in acute dissection.     

Paradigmenwechsel in der Chirurgie der komplexen thorakalen Aortenerkrankung

One of the main issues in complex thoracic aortic disease, requiring the replacement of the ascending aorta, the entire aortic arch and the descending aorta, is the vast amount of surgery necessary to cure the patient. Though one-stage repair is feasible by a clamshell thoracotomy, the associated surgical trauma and perioperative morbidity limit this approach to younger patients only. Classic surgical repair consist of a two-stage strategy, whereby, in the first step, the ascending aorta and the aortic arch are replaced via a midline sternotomy. In the second step, via a lateral thoracotomy, the descending aorta is replaced. The two stages may sum up to a mortality of 20%; furthermore, the waiting period between the stages is associated with a mortality rate of 10% of its own. Additionally, the two-stage strategy has an inherent limitation, due to the comorbidity and advanced age of the majority of patients. Therefore, the second stage cannot be offered to up to 30% of patients. New developments and improvements in aortic surgery were introduced to overcome these shortcomings and to simplify the surgical repair. The "elephant trunk" principle, introduced by Borst et al. in 1983, was an important step to facilitate surgical repair, but still required the second step. With the introduction of endovascular repair of thoracic aortic disease with stent grafts implanted retrograde via the femoral artery, new therapeutic concepts emerged. In the late 1990s, two Japanese groups reported first trials to stabilize the free-floating "elephant trunk" prosthesis by implantation of nitinol stent grafts into the vascular graft. The applied devices were purely custom-made and nonstandardized. The availability of industrially made and CE-marked stent-graft devices raised the possibility to apply them in open aortic arch surgery. The experience with stent-graft devices implanted antegrade into the descending aorta (Medtronic Talent) was reported first by the Essen and the Vienna group. The experience gained with these devices revealed the limitations of the devices designed for pure retrograde aortic delivery. This required a complete redesign and new construction of the stent graft itself as well as the introducer system. In a preliminary series of 14 patients the required stent-graft properties were presented in detail and resulted in the first industrially manufactured standardized and CE-marked Hybrid stent graft (Essen 1 prosthesis, E-vita Open, Jotec), especially made for antegrade open stent grafting of the descending aorta. This device consists of a stent graft with an integrated Dacron vascular prosthesis, enabling for direct and continuous aortic arch replacement after stent grafting of the descending aorta. From 01/2005 to 03/2006, this hybrid prosthesis was implanted in 16 patients (one aneurysm and 15 aortic dissections). In all cases, the underlying pathology within the thoracic aspect of the aorta could be excluded in a one-stage approach. In case of aortic dissection, thrombosis of the false lumen was detectable by transesophageal echocardiography already at the end of surgery. Though long-term results using this new method are not yet available, the initial promising results postoperatively are encouraging toward true one-stage repair by combining classic aortic surgery with open antegrade stent grafting utilizing the newly designed hybrid prosthesis. While surgical trauma is markedly reduced, this treatment option can be offered to elderly patients as well.     

Retrograde type A dissection after endovascular stent grafting of type B dissection

Acute aortic dissection is a disease with high mortality. Whereas acute dissection of the ascending aorta (Standford type A) is treated surgically, acute dissection of Stanford type B (descending aorta) is principally treated conservatively, but surgically in case of complications. Recently, another therapeutical option for the treatment of type B dissection has been developed using endovascular stent-grafts. We report on a 64-year-old woman with typical signs of acute aortic dissection. Computer tomography and transesophageal echocardiography demonstrated Stanford type B dissection. The patient was treated with an endovascular stent-graft, because of malperfusion of the right leg and chest pain. After successful closure of the entry by the stent, the patient developed acute right-sided hemiplegia one day after the intervention due to retrograde dissection into the aortic arch and ascending aorta. Upon immediate operation, the origin of the initially type B dissection was still sufficiently occluded by the endovascular stent-graft; however, there was another entry between the innominate artery and the left carotic artery near one proximal end of the stent's strut. Using deep hypothermia and selective antegrade cerebral perfusion, the ascending aorta and proximal arch were replaced with a 28 mm Dacron-Velour tube and the aortic root was remodelled with a tongue-shaped Dacron graft preserving the valve cusps according to a modified Yacoub procedure. After the operation, neurological symptoms diminished and the patient could walk on the ward on day eleven. This case demonstrates retrograde type A dissection as a complication after interventional treatment of type B dissection using an endovascular stent-graft. The reason for this delayed complication is speculative. Aortic wall damage during stent inserting could be a possible cause. It is also likely that the patient initially had type B dissection with retrograde dissection of the distal part of the aortic arch. Therefore, one of the straight struts of the proximal end of the stent may have caused additional damage to the vulnerable dissected aortic wall in the arch, leading to retrograde type A dissection. Careful patient selection, detailed diagnosis of the aortic arch, improved stent designs and materials, especially regarding the stent's ends and careful insertion of the stent into the aortic arch, could contribute to prevention of the described problems.     

支架型人工血管介入治疗主动脉夹层动脉瘤及主动脉穿透溃疡30例报告

目的探讨支架型人工血管介入治疗主动脉夹层动脉瘤和主动脉穿透溃疡的可行性及疗效。方法2001年6月至2004年3月,行支架型人工血管治疗主动脉夹层动脉瘤及主动脉穿透溃疡30例。男性24例,女性6例。平均年龄(523±119)岁。25例主动脉夹层动脉瘤中,慢性TypeB23例,急性TypeB1例,TypeA1例。主动脉穿透溃疡5例。术后随诊1～32个月。结果30例支架型人工血管均成功植入。5例有近端内漏,1例术中发生升主动脉夹层,2例分别在术后1d、7d发生升主动脉夹层。术后30d内死亡2例。术后30d内死亡率为67%。1例术后20个月因近端内漏接受第2次支架型人工血管植入术。术后随诊1～32个月,无死亡,亦无支架移位、狭窄等并发症。结论支架型人工血管是治疗主动脉夹层动脉瘤和主动脉穿透溃疡的有效方法,中远期效果还有待进一步观察。     

Restoration of the thoracic aorta in Type A dissection with hybrid prosthesis

Following successful repair of Type A dissection, late morbidity and mortality depend on the progression of residual chronic Type B dissection. To avoid the development of late aneurysms of the descending thoracic aorta, a persistent aortic false lumen around the stent-graft can be prevented by remodeling the thoracic aorta. Ten consecutive patients (mean age: 56 years) with acute Type A dissection underwent a "frozen elephant trunk operation" with the E-vita hybrid prosthesis, under deep hypothermic circulatory arrest, between October 2009 and April 2010. The thoracic aorta was restored to its original size. Computed tomography was used to size the aortic diameter. All patients survived and were routinely discharged. Postoperative computed tomography showed no remaining false lumen and no distal organ ischemia in any patient. No new neurological complication was recorded. Two patients suffered postoperative pulmonary arterial embolism; one underwent embolectomy. Restoration of the thoracic aorta is a safe procedure to close the false lumen during the primary operation for acute Type A dissection. However, the diameter of the stent should reflect the overall aortic size, independent of the diameter of the true lumen.     

覆膜支架腔内治疗急性胸主动脉综合征

目的 评价覆膜支架腔内治疗急性胸主动脉综合征的有效性和安全性。方法 2001年5月至2005年12月应用覆膜支架治疗57例急性胸主动脉综合征患者,其中急性主动脉B型夹层45例,穿透性粥样硬化性溃疡（PAU）或假性动脉瘤9例,创伤性胸主动脉瘤3例。建立数据库,分析其临床特点、疗效及随访结果。结果 57例患者覆膜支架置入技术成功率100％。5例有近端内漏,1例术中出现升主动脉夹层,未予特殊处理,随访结果良好;1例术后7天出现升主动脉夹层并发心包填塞死亡。5例PAU或主动脉夹层合并冠心病患者,在应用覆膜支架成功完全封闭破口后立即行冠状动脉介入治疗成功。1例出现术后一过性双下肢无力,经静脉滴注山莨菪碱和甘露醇2天后痊愈。1例支架覆盖左锁骨下动脉开口导致左椎动脉缺血,嗜睡2天后自行好转。术后重症监护病房时间1～8（平均3．5）天,术后平均住院10天。术后30天内死亡2例,1例死于升主动脉夹层破裂,1例死于急性肾衰竭。术后30天内死亡率3．5％。术后平均随访（25．3±13．1）（13—55）个月。1例于术后3个月死于大咯血,1例死因不明。1例因近端内漏行二次腔内修复术。5例患者因降主动脉覆膜支架远端再发现破口,行二次腔内修复术。术后截瘫发生率为0,无支架移位、狭窄等并发症。术后住院及随访期内总死亡率为7．0％。与传统手术相比,腔内治疗急性胸主动脉综合征具有创伤小、严重并发症少、住院时间较短的优势。结论 覆膜支架是治疗急性胸主动脉综合征优良且有效的方法,也可用于外科手术高风险患者,近中期随访结果良好,远期结果有待于进一步随访。     

Endovascular treatment of thoracic aortic disease: mid-term follow-up.

OBJECTIVE: The aim of this study was to evaluate the mid-term follow-up in a cohort of patients with acute or chronic descending aortic disease treated by stent-graft repair. BACKGROUND: Since 1999, endovascular stent-graft placement has been reported as an alternative treatment to surgical approach for a variety of thoracic aortic diseases; however, results beyond initial short-term follow-up are not widely available for the broad range of applications. METHODS: From March 2001, 43 consecutive patients with traumatic aortic transection (group A = 16) and complicated type B aortic dissection or aneurysm (group B = 27) underwent stent-graft implantation. All patients underwent computed tomography (CT) scan as preoperative assessment and in 26 a transesophageal echo (TEE) exam was performed. RESULTS: Technically successful stent-graft deployment was achieved in all patients. No patient required surgical conversion and no cases of paraplegia occurred. The overall in-hospital mortality was 9.3%. A residual endoleak (type II) was detected in one group B patient who was managed conservatively. The mean follow-up was 29 +/- 8 months (range 10-48 months). No patient died during late follow-up after hospital discharge. At 12 months, one patient (2.5%) who had stent graft repair of an aortic dissection developed an asymptomatic type I endoleak. Three asymptomatic patients with chronic dissection had a persistent retrograde perfusion of the thoracic false lumen via a distal tear(s) in the dissection septum. CONCLUSION: Our results of stent-graft treatment of complicated and uncomplicated diseases of the descending aorta confirms that this alternative to open repair is a safe, less invasive, and relatively low risk approach. Medium-term follow-up results suggest that it is effective and durable therapy with low associated mortality and morbidity rates.     

覆膜支架植入治疗急性期主动脉夹层的临床研究

目的:探讨应用覆膜支架治疗急性期主动脉夹层的疗效及安全性。方法:对20例急性期StanfordB型主动脉夹层患者行覆膜支架植入治疗、随访并评价疗效。结果:20例患者均成功植入覆膜支架,5例出现内漏,4例重复扩张后内漏消失,1例再植入支架后内漏消失。术中及术后无严重并发症发生。结论:覆膜支架植入术对于急性期StanfordB型主动脉夹层患者,是一种安全、有效的治疗方法。