急性B型主动脉夹层的腔内治疗

目的 讨论腔内修复术(endovascular repair,EVR)对治疗急性B型主动脉夹层(acuteaortic dissection,AAD)的安全性及有效性.方法 回顾性分析2002年2月至2008年3月收治的39例急性B型主动脉夹层患者的临床资料.EVR按常规方法进行,2例需覆盖左颈总动脉而行旁路术,其中1例同时无名动脉支架型血管(stent graft,SG)开窗术;1例因肢体严重缺血同期行左下肢截肢术.13例完全覆盖左锁骨下动脉,1例覆盖迷走右锁骨下动脉,5例部分覆盖左锁骨下动脉(leftsubclavian artery,LSA).术后全部病例均经CTA(computer tomography angiography)随访,并监测支架覆盖段(Ll)及支架远端(L2)主动脉段的假腔变化.结果 所有支架释放到预定位置;30 d死亡率10.3%.术后1个月L段假腔血栓率100%,完全血栓率77.8%(21/27例),部分血栓率22.2%(6/27例),其中18.5%(5/27例)达到血栓完全吸收、主动脉重塑;L2段假腔血栓率28%,完全血栓率8%(2/25例),部分血栓率20%(5/25例).结论 急性B型主动脉夹层腔内修复术治疗效果肯定,30 d内死亡主要与术前伴随的并发症有关.

Endovascular repair of type B acute aortic dissection

Objective To evaluate the safety and efficacy of endovascular repair(EVR)for type B acute aortic dissection(AAD). Methods Between Feb 2002 and May 2008.39 consecutively admitted patients with the confirmed diagnosis of acute type B aortic dissection were studied.All patients were treated bv EVR.Left comnlon carotid artery were covered after bypass in 2 cases.of which fenestrated stent graft (SG)at innominate artery was used in one;1 case underwent left lower extrernity amputation:13 left subclavian artery(LSA)and 1 aberrant risht subclavian artery were completely covered without bypass.5 LSA were pattially covered.All cases were followed by CTA after EVR.the porfusion status of the false lumen were monitored in the aorta at the level of the stented segment(L1)and distal to the stent graft (L2).Results The procedure Was technically successful in all cases;30-day mortality rate was 10.3%.At the 1-month follow-up,false lumen in L1 thrombosed in 100%,a complete thrombosis of the false lumen Was observed in 21 patients(77.8%).partial thrombosis in 6(22.2%).with complete reabsorption of the thrombus and remodelling of the true lumen in 5(18.5%);False lumen in L2 thrombosed only in 7 patients(28%),complete thrombosis in 2(8%)and partial thrombosis in 5(20%).Conclusions The results of endovascular repair of acute type B dissection Was satisfactory.30-day mortalitv rate was related to severe complications before EVR.