主动脉腔内支架隔绝术治疗降主动脉瘤

目的探讨主动脉腔内支架隔绝术治疗降主动脉瘤的适应证和疗效。方法2005年3月-2008年10月,对21例典型B型（Stanford分型）主动脉夹层、5例假性动脉瘤、2例主动脉壁内血肿合并主动脉壁溃疡,在局麻（26例）或全麻（2例）下行主动脉腔内支架隔绝术。采用Medtronic Talent支架10例,Medtronic Valiant支架12例,微创直管型支架6例。结果28例手术均获成功,术后即刻造影示破口封闭,无内漏。术后无胸痛,无神经系统并发症,无内漏,术后住院时间（4.5±1.1）d,3-7 d。5例术后发热,吲哚美辛治疗1个月,体温正常。21例主动脉夹层术后1周CT扫描显示真腔扩大,血供明显改善,胸主动脉假腔内血栓形成,腹主动脉假腔存在,开口于假腔的分支靠远端破口供血;5例假性动脉瘤CT扫描显示破口封闭,假腔内血栓形成;2例壁内血肿CT扫描显示溃疡被支架覆盖。23例随访（21.3±10.2）月（1-40个月）,无并发症发生。结论主动脉腔内支架隔绝术疗效可靠,操作简单,创伤小,患者恢复快,并发症少,住院时间短。B型主动脉夹层、降主动脉假性动脉瘤和降主动脉壁内血肿均可采用腔内支架隔绝术治疗。

Endovascular Stenting for the Treatment of Thoracic Aortic Aneurysm

Objective To investigate the indications and efficacy of endovascular stenting for the treatment of thoracic aortic aneurysm. Methods From March 2005 to October 2008, 21 patients with Stanford type B aortic dissection, 5 cases of pseudoaneurysm, and 2 patient with intramural hematoma complicated with ulcer of the aortic wall were treated by endovascular stenting under general （2 cases） or local （26 cases） anesthesia in our hospital. Medtronic Talent stent was employed in 10 cases, Medtronic Valiant stent was used in 12, and microinvasive straight-type stent was used in 6 patients. Results The operation was completed successfully in all of the 28 cases. Angiography showed that the gaps in the aorta were closed without endoleak. No patient had chest pain or neurological complications. The patients were discharged in （4.5 ± 1.1 ） days （ range 3 - 7 days）. Five patients developed fever after the operation and were cured by indomethacin in one month. One week after the surgery, in 21 cases, CT scan showed enlarged aortic dissection, improved blood supply, thrombus in the false lumen of the thoracic aorta, and a false lumen in the abdominal aorta. In the 5 cases with pseudoaneurysm, CT scan confirmed that the rupture was closed with thrombus being detected in the lumen. The aortic ulcers that were detected in the 2 cases, who had intramural hematoma, were covered by the stents. Of the patients, a follow-up of （21.3 ±10.2） months （range 1 -40 months） was available in 23 patients, who had no complications during the period. Conclusions Endovascular stenting is a simple, safe and effective method for Stanford type B aortic dissection, pseudoaneurysm, and intramural hematoma, resulting in quick recovery, less complications, and short hospital stay.