急诊腔内修复术治疗合并灌注不良综合征的急性Stanford B型主动脉夹层

目的：探讨急诊行腔内修复术治疗合并灌注不良综合征的急性Stanford B型主动脉夹层的疗效及安全性。方法：2006年1月—2013年12月，共收治23例合并灌注不良综合征的急性Stanford B型主动脉夹层患者，患者治疗前均经全主动脉CT血管造影确诊。其中男16例，女7例，年龄42~68岁；合并肾动脉灌注不良8例（单侧6例），肠系膜上动脉灌注不良9例，单侧下肢动脉灌注不良5例，脊髓灌注不良1例；17例患者急诊行腔内修复术及相关辅助治疗，6例患者拒绝手术，予保守治疗。结果：6例保守治疗患者均在2周内死亡。17例接受急诊手术患者均予覆膜支架封堵主动脉第一破口，其中13例封堵第一破口后，分支动脉灌注不良改善；1例第一破口位于降主动脉中段，先植入裸支架，扩张主动脉真腔后，再植入覆膜支架封堵第一破口；3例封堵第一破口后，尚需再植入单侧肾动脉或肠系膜上动脉裸支架。术后30 d无死亡病例。17例均随访3~36个月，1例术后半年死于心肌梗死，余均存活且未出现支架相关并发症。结论：对于合并器官灌注不良的急性Stanford B型主动脉夹层患者，急诊行腔内修复术，恢复脏器供血，是挽救生命的重要方法。

Emergent endovascular repair for acute Stanford type B aortic dissection with malperfusion syndrome

Objective: To evaluate the safety and efficacy of emergent endovascular repair for acute Stanford type B aortic dissection with malperfusion syndrome.Methods: Between January 2006 and December 2013, a total of 23 patients with acute Stanford type B aortic dissection and concomitant malperfusion syndrome were admitted, and all patients were reliably diagnosed by CT angiography of the whole aorta before operation. Of the patients, 16 cases were male and 7 were female, and aged 42 to 68 years; 8 cases were complicated with renal malperfusion (6 cases were unilateral), 9 cases had malperfusion of the superior mesenteric artery, 5 cases had unilateral lower extremity malperfusion, and one case suffered from spinal cord malperfusion; 17 cases received emergent endovascular repair and associated adjuvant treatment, and 6 cases who refused the procedure underwent conservative treatment.Results: All the 6 patients undergoing conservative treatment died within 2 weeks. Closure of the primary entry tear with a covered stent-graft was performed in all of the 17 patients who received emergent operation; among whom, malperfusion of the aortic branches was improved in 13 cases after closure of the primary entry tear; in one case with the primary entry tear located at the middle portion of the descending aorta, a bare stent placement was performed first to dilate the true lumen and then the primary entry tear was closed with a covered stent-graft; 3 patients underwent additional bare stent placement for one renal artery or superior mesenteric artery after closure of the primary entry tear. No death occurred in 30 d after operation. During the follow-up period of 3 to 36 months for the 17 patients, one case died due to myocardial infarction 6 months after operation, while all the remaining patients were alive and no stent-related complications were observed.Conclusion: Emergent endovascular repair with restoration of visceral organ blood flow is important method for saving the lives of patients with acute Stanford type B aortic dissection and concomitant malperfusion syndrome.