腔内隔绝术治疗Stanford B型夹层动脉瘤

目的 探讨腔内隔绝术EVGE治疗Stanford B型夹层动脉瘤的价值及应用经验。方法采用国产人工覆膜支架治疗Stanford B型夹层动脉瘤9例。经核磁共振（MRI）、主动脉造影明确瘤体和夹层破口位置及大小,标记破口位置。准确选定覆膜支架型移植物,DSA监控下将支架导入瘤腔及裂口位置,完全封闭破口,使真、假腔隔绝。结果破口全部封闭成功,支架没有移位、狭窄等并发症。术后超声和螺旋CT检查假腔内有血栓形成。9例患者均康复出院。结论EVGE是一种治疗Stanford B型夹层动脉瘤的有效方法,早期结果满意,中远期效果还有待进一步观察。     

管腔内支架人工血管治疗主动脉夹层

目的 探讨应用腔内支架人工血管植入治疗DeBakeyⅢ型主动脉夹层的适应症、操作技巧及并发症防治。方法 对18例DeBakeyⅢ型主动脉夹层在全麻下行腔内支架人工血管植入术，经左上肢置入造影导管造影，经股动脉导入支架人工血管植于夹层破口处封闭破裂口。结果18例共植入支架人工血管20只，2例发生内漏，均经加放一只支架人工血管封堵成功。操作成功率100％，无手术死亡。近期、中期效果良好。结论 支架人工血管植入术治疗DeBakeyⅢ型主动脉夹层具有创伤小，恢复快的特点，尤其适用于病人体质差，有合并症及外科手术禁忌的病人，近期效果良好．远期效果有待观察。     

主动脉夹层腔内隔绝术围术期护理

主动脉壁内膜破裂,高速的血流通过破口将动脉的内膜和中膜分离,血液从中流动,过去称为主动脉夹层动脉瘤,现称为主动脉夹层血肿,简称主动脉夹层。血管腔内隔绝术（endovasculargraftexclusion,EVGE）是指经股动脉导入人工导管,以内支架固定于动脉壁上,将血液与瘤壁隔绝,使瘤壁免受血流冲击,以达到治疗目的的一种介入治疗方法。我院2006年1月至2010年3月共收治DeBakeyⅢ型主动脉夹层51例,现将主动脉夹层腔内隔绝术围术期护理报告如下。     

9例急性主动脉夹层动脉瘤腔内隔绝治疗术的护理

总结9例急性主动脉夹层动脉溜Stanford分型B型、A型带膜支架植入腔内隔绝治疗术前护士耐心、细致、体现人文关怀的心理护理是患者积极配合治疗护理的基础；严密的血压监测控制，有效的疼痛治疗，心肺功能监测，以及术后病情的严密观察，有效处理是患者安全渡过危险期、手术期的保证。     

探讨主动脉夹层动脉瘤腔内隔绝术并气管切开后病人的护理

目的 总结主动脉夹层动脉瘤病人实施腔内隔绝术并气管切开后的护理要点。方法回顾性分析了我院43例病人实施腔内隔绝术后转入病房的临床资料和护理记录。结果 5例病人术后进行气管切开，需要较长时间的治疗和护理。结论 重视病人的心理反应给予良好的心理支持，加强专科病情的观察，做好气管切开的护理，给予明确细致的饮食指导等护理能有效促进病人的康复。     

夹层动脉瘤腔内隔绝术围手术期护理

目的探讨夹层动脉瘤腔内隔绝术围手术期护理体会。方法对18例夹层动脉瘤拟行腔内隔绝术患者进行围手术期护理,术前作好入院指导及心理护理,调整患者心理状态以适应手术,防止夹层动脉瘤破裂;术后注意作好呼吸、循环系统的护理及尿量的观察,提高成功率,并进行总结。结果18例主动脉带膜支架全部成功植入,术后除3例发热外无其它并发症发生,均在2周内康复出院。结论尽管夹层动脉瘤腔内隔绝治疗系微创手术,但其本身有一定的并发症,加强围手术期护理,预防并及时处理并发症是提高手术成功率、保障患者痊愈的重要环节。     

腔内隔绝术治疗Stanford B型主动脉夹层23例临床分析

目的探讨Stanford B型主动脉夹层动脉瘤腔内隔绝术治疗的手术指征、术前评估方法、手术操作技巧、并发症及防治原则；观察近、中期临床疗效。方法自2003年3月～2006年1月，对23例Stanford B型主动脉夹层动脉瘤患者行腔内隔绝术治疗，笔者对临床资料进行回顾性分析。术前采用CT血管造影（CTA）或磁共振血管造影（MRA）对主动脉夹层动脉瘤进行评估，术中在数字减影血管造影（DSA）监视下经股动脉将移植物导入胸主动脉封闭夹层裂口，术后行影像学及症状学随访观察。结果术中成功释放移植物22例，术后即刻DSA造影显示18例近段破口完全被封闭，动脉瘤消失，4例发生内漏，其中2例再次置入支架后内漏消失。术后2例患者发生腹主动脉夹层，其中1例再次行腔内隔绝术。1例患者发生肠系膜动脉栓塞引起肠坏死而死亡。22例患者术后无心、肺、肾功能衰竭及截瘫等并发症，术后生命体征平稳，切口愈合，出院，术后经过CTA及症状学随访显示无严重并发症，生活质量明显提高。结论腔内隔绝术是一种创伤小、恢复快的新方法，近、中期随访结果表明该技术安全、有效。     

腹主动脉瘤腔内隔绝术并发主动脉夹层破裂致心包填塞尸检1例

死者,女性,78 岁,因体检发现腹主动脉瘤就诊.入院后第2天行腹主动脉瘤腔内隔绝术,在术后麻醉苏醒期,患者突然出现心率及血压聚降,后抢救无效死亡.既往临床诊断:(1)高血压;(2)肾下型腹主动脉瘤;(3)主动脉及其部分分支硬化;(4)冠状动脉硬化. 尸体检查 眼观:老年女尸,发育正常,营养良好."T"字形切口,打开胸、...     

主动脉夹层带膜支架腔内治疗及其进展

主动脉夹层是主动脉腔内的血液从主动脉内膜撕裂口进入主动脉中膜,使中膜分离,并沿主动脉长轴方向进展,从而造成主动脉真、假腔两腔分离的一种病理改变。本病住院期间的总死亡率为27．4％^[1]。     

覆膜支架介入治疗外伤性主动脉夹层动脉瘤术后的护理

目的 讨论覆膜支架植入治疗外伤性主动脉夹层动脉瘤术后的护理.方法 2006年12月～2010年10月,采用先健AnkuraTM大动脉覆膜支架系统施行EVGA术的病人有5例,男4例,女1例,年龄31～55岁.护理积极配合医生治疗,严密观察病人的生命体征,做好健康教育.结果 5例患者支架全部成功植入.术前血压控制平稳,5例术中无并发症及死亡发生.术后2月～4年随访,所有患者复查CT示假腔径缩小并见腔内血栓形成,真腔径增大,未发生瘤体破裂及支架移位等并发症.结论严密、认真的护理措施对外伤性主动脉夹层覆膜支架植入术的成功和病人的康复有重要意义.     

腔内隔绝术在主动脉瘤外科治疗中的应用

目的：探讨腔内隔绝术治疗主动脉夹层动脉瘤、腹主动脉瘤的操作方法及近期疗效。方法：采用腔内隔绝术治疗主动脉夹层动脉瘤3例、腹主动脉瘤2例。结果：5例主动脉瘤腔内隔绝术均获得成功，术后3例主动脉夹层动脉瘤的假腔立刻消失，2例腹主动脉瘤瘤体成功隔绝。无支架移位；术中发生内漏1例，经及时处理后消失；2例术后出现移植后综合征，经对症处理后缓解。随访3-21个月，无移植物移位及器官缺血，假腔内见血栓形成。结论：腔内隔绝术治疗主动脉瘤创伤小．安全、恢复快，有着较好的近期效果。     

Endovascular repair of thoracic aortic aneurysm

A thoracic aortic aneurysm (TAA) is a potentially life-threatening condition with structural weakness of the aortic wall, which can progress to arterial dilatation and rupture. Today, both an increasing awareness of vascular disease and the access to tomographic imaging facilitate the diagnosis of TAA even in an asymptomatic stage. The risk of rupture for untreated aneurysms beyond a diameter of 5.6 cm ranges from 46% to 74% and the two-year mortality rate is greater than 70%, with most deaths resulting from rupture. Treatment options include surgical and non-surgical repair to prevent aneurysm enlargement and rupture. While most cases of ascending aortic involvement are subject to surgical repair (partially with valve-preserving techniques), aneurysm of the distal arch and descending thoracic aorta are amenable to emerging endovascular techniques as an alternative to classic open repair or to a hybrid approach (combining debranching surgery with stent grafting) in an attempt to improve outcomes.     

杂交手术治疗累及弓部的主动脉夹层的临床研究

目的 探讨杂交手术治疗累及主动脉弓部的主动脉夹层的方法及疗效.方法 自2009年1月至2012年1月,成都军区总医院共对16例累及主动脉弓部的主动脉夹层患者完成了杂交手术治疗.其中男性11例,女性5例,年龄50～72岁[(56.3±7.1)岁].Stanford A型主动脉夹层(夹层起源于升主动脉)5例,B型夹层(夹层起源于降主动脉)11例,病变均累及主动脉弓,不适宜单独行腔内隔绝治疗.11例采用胸骨正中切口或加颈部切口行升主动脉至头臂动脉旁路移植,5例单纯颈部切口行头臂动脉间旁路移植,然后行股动脉切口逆行主动脉腔内覆膜支架植入.术后即刻行升主动脉造影,术后3个月、1年及2年随访CT资料,观察支架和人工血管通畅情况.结果 所有患者均成功完成血管旁路手术,并植入覆膜支架.术中血管造影证实支架植入定位准确,无明显内漏和移位.主动脉夹层真腔血流恢复正常,旁路血管血流通畅,围手术期无死亡和严重并发症发生.随访16例,随访时间3.0 ～ 48.0个月[(24.O±8.2)个月],所有患者均生存,并恢复正常生活.术后3个月和术后1年、2年复查主动脉增强CT示:支架无移位和内漏,支架内及人工血管旁路血流通畅,未见脑部和肢体的缺血征象.结论 累及弓部的主动脉夹层可根据受累的部位及程度采用不同的杂交手术方法,杂交手术治疗累及主动脉弓部的主动脉夹层安全、有效,能明显减轻患者的创伤和痛苦,该治疗方法扩大了介入覆膜支架腔内治疗的适应证,但远期疗效有待迸一步观察.     

覆膜支架介入治疗主动脉夹层动脉瘤的麻醉处理

目的探讨覆膜支架介入治疗主动脉夹层动脉瘤的麻醉处理及注意事项。方法16例DeBakeyⅢ型主动脉夹层动脉瘤在全身麻醉和控制性降压下施行经股动脉覆膜支架介入治疗术。麻醉采用丙泊酚和瑞芬太尼为主的全凭静脉麻醉,持续监测心电图,连续桡动脉测压,脉搏血氧饱和度,中心静脉压,呼气末二氧化碳分压和尿量,计算心率收缩压乘积(RPP),以硝普钠控制术中收缩压在90~120mm Hg,在释放支架时将收缩压控制在70~90mm Hg。术毕及时建立术后镇痛。结果手术时间为(148.16±23.25)min,麻醉效果满意,血流动力学稳定,术中收缩压90~120mm Hg,心率70~80次/min,RPP<12000,释放支架时收缩压为(78.2±6.3)mm Hg。术毕病人清醒快,无躁动,顺利拔管。随访无麻醉相关并发症。结论全身麻醉及控制性降压用于覆膜支架介入治疗主动脉夹层动脉瘤效果良好。     

胸主动脉腔内覆膜支架修复术对TBAD患者的影响

目的探讨胸主动脉腔内覆膜支架修复术对Stanford B型主动脉夹层(TBAD)患者的影响。方法选取我院收治的96例TBAD患者的临床资料,按照患者意愿分为联合组和对照组,每组48例。对照组给予药物治疗,联合组在对照组基础上联合胸主动脉腔内覆膜支架修复术治疗。比较2组患者住院时间、院内病死率、治疗前及治疗后1个月主动脉血管重塑情况,检测2组患者治疗前及治疗后1个月心功能指标左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、每搏心输出量(SV),肝肾功能指标丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酐(Cr)、尿素氮(BUN)及外周血中性粒细胞与淋巴细胞比值(NLR)、D-二聚体(D-dimer)、心型脂肪酸结合蛋白(H-FABP)水平。术后随访12个月,采用Kaplan-Meier曲线分析2组患者生存状况。结果联合组住院时间短于对照组,院内病死率低于对照组(P<0.05)。治疗后1个月,联合组主动脉峡部段、降主动脉中段、降主动脉远段真腔短径长于对照组,假腔短径短于对照组(P<0.05);联合组LVEDD、LVESD短于对照组,LVEF、SV高/大于对照组(P<0.05);联合组血清ALT、AST、Cr、BUN低于对照组(P<0.05);联合组外周血NLR、D-dimer、H-FABP水平低于对照组(P<0.05)。Kaplan-Meier曲线分析显示,联合组术后12个月生存率高于对照组(P<0.05)。结论胸主动脉腔内覆膜支架修复术治疗TBAD可降低外周血NLR、D-dimer、H-FABP表达,改善主动脉血管重塑情况、心功能、肝肾功能,缩短住院时间,降低院内病死率,改善预后。     

Stent graft treatment for thoracic and thoracoabdominal aortic disease using a unibody Z-stent that adapts to flexure

Positioning a stent graft (SG) that adapts to the anatomical shape of the aorta is important to prevent complications after SG procedures to treat aortic disease. The Gianturco Z-stent has several benefits, but its rigid structure prevents adaptation to flexure. We improved this stent and studied its ability to adapt in the clinical environment. We positioned SGs and inspected their adaptability to flexure in an aortic arch model. We examined several gap lengths and strut directions, and determined the distance generated between the stent and the aortic wall. We found that adaptation was quite satisfactory with a gap of more than 10 mm or when the struts faced the major flexure or the side of the model aorta. Based on these findings and to facilitate placement, we manufactured the unibody Z-stent with 10-mm gaps. The unibody Z-stent was applied to treat thoracic and thoracoabdominal aortic disease in seven patients. The SG was positioned from the femoral or iliac artery in five patients and from an anastomosed graft to the ascending aorta after median sternotomy and bypass of the arch branches in two patients. A minor endoleak developed in one patient. None of the other six patients developed complications or died during the procedure, although one patient died in the hospital due to cerebral infarction. The unibody Z-stent was applied as a SG that adapts to flexure of the aorta and was easy to apply. The frequency of complications was apparently decreased after clinical application of the unibody Z-stent in SG treatment for thoracic and thoracoabdominal aortic disease.     

Endovascular treatment of bilateral carotid artery occlusion with concurrent basilar apex aneurysm: a case report and literature review

We report a case of successful endovascular treatment of bilateral carotid artery occlusion with concurrent basilar apex aneurysm. An elderly female patient with subarachnoid hemorrhage (SAH) onset was admitted to the hospital. Computed tomography (CT) and digital subtraction angiography (DSA) confirmed the presence of bilateral carotid artery occlusion with concurrent basilar apex aneurysm. Brain blood supply was provided by the bilateral vertebral artery through the basilar artery. We treated the aneurysm with the endovascular approach by embolizing the aneurysm with three coils. The patient recovered well after surgery and showed no recanalization of the aneurysm on a one-year follow-up DSA. We also reviewed six similar cases found with a PUBMED database search (1980-2010), including those with bilateral common carotid artery occlusion. In conclusion, by using the endovascular approach, bilateral carotid artery occlusion with concurrent basilar apex aneurysm was efficiently treated.     

Abdominal aortic aneurysm and cytomegalovirus infection

Cytomegalovirus (CMV) has been implicated in the pathogenesis of atherosclerosis. Abdominal aortic aneurysm is regarded traditionally as a consequence of atherosclerosis. Several microorganisms have been suggested as possible contributing factors for the development of abdominal aortic aneurysm. The relevance of CMV in the processes underlying the development, expansion, and rupture of abdominal aortic aneurysm is unknown. The aim of the present study was to investigate whether CMV infection is related to abdominal aortic aneurysm rupture. One hundred nineteen patients with abdominal aortic aneurysm and 36 matched controls without abdominal aortic aneurysm were investigated prospectively by CMV serology. Patients with ruptured abdominal aortic aneurysm have similar levels of IgG antibodies against CMV as patients with nonruptured abdominal aortic aneurysm, small abdominal aortic aneurysm, and controls without abdominal aortic aneurysm. In conclusion, this study fails to demonstrate a connection between CMV infection and abdominal aortic aneurysm rupture.