胸主动脉夹层动脉瘤腔内隔绝术中内漏的处理对策

目的：探讨胸主动脉夹层动脉瘤（TAD）腔内隔绝术（EVGE）中内漏的评估、处理和预防方法。方法：对116例接受EVGE的Stanford B型TAD患术中出现的内漏采单纯球囊扩张、增加延伸移植物（cuff）封堵和促凝的方法进行处理。结果：术中出现中即时内漏17例（14.65%，17／116),10例采用球囊扩张。8例有效（内漏量减少），无治愈病例；10例采用cuff，均有效，治愈7例；4例采用促凝处理，有效、治愈各1例。术中处理后带漏9例（7.76%,9/116）。内漏组死亡2例（10.50%），非内漏组死亡2例（2％）。结论：对于TAD患，单纯球囊扩张对EVGE术中内漏尤其近端内漏的治疗效果并非最佳，cuff是最有效的治疗方式。

Management of endoleaks in endovascular graft exclusion for thoracic aortic dissection

Objective:To study the optimal choice to evaluate, treat and prevent endoleaks in the procedure of endovascular graft exclusion (EVGE) for thoracic aortic dissection (TAD). Methods:The endoleak cases among 116 patients received EVGE were managed by ballooning, cuffing and coagulate promoting methods. Results:Endoleaks were detected in 17 cases immediately after the stent graft(SG) were deployed (14.65%). The effective ratio of simple ballooning was 8/10;while the curative ratio was zero. The effective ratio of additional cuffs was 10/10, and the curative ratio was 7/10. The coagulation control method only had a 1/4 effective and curative ratio. Conclusion:For TAD patients, the simple ballooning in the EVGE procedure is not the optimal management for the proximal endoleaks, cuffing is the effective treatment.