Early Results of Thoracic Endovascular Aortic Repair for the Management of Acute Uncomplicated Type B Aortic Dissection

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Stanford B型主动脉夹层的腔内治疗（附134例报告）

目的探讨腔内胸主动脉修复术治疗Stanford B型夹层的临床价值。方法对我院2006年1月～2011年8月134例行腔内胸主动脉修复术的B型主动脉夹层患者的治疗情况进行回顾性分析。男93例,女41例。年龄32～82岁,（56.4±8.3）岁。全麻,数字减影动脉造影（digital subtraction angiography,DSA）监控下,切开股动脉,将带膜支架置于胸主动脉内膜破口处封堵破口。结合术前影像学、术后门诊影像学随访资料,观察夹层病变演化过程,观察有无内漏、移位和人工血管内支架塌陷等术后并发症。结果 134例原发胸主动脉夹层破口均完全封闭,真腔血流恢复,原受损脏器功能恢复正常。释放支架165枚。围手术期死亡2例,随访死亡1例。90例获得随访,随访时间3～63个月,（25.6±8.4）月,主动脉CT血管成像（CT angiography,CTA）复查显示无内漏、移位等并发症。12例支架尾部破口,再次行腔内隔绝,1例术后逆行性A型夹层。结论腔内胸主动脉修复术治疗Stanford B型夹层具有技术可靠、安全性高、术后恢复快等优点,临床应用前景良好。     

Thoracoabdominal Endaortectomy in Case of Type B Aortic Dissection

Despite remarkable progress in both, diagnostic and therapeutic development in treating aortic dissections, this continues to be one of the most severe vascular disorders and is subject to high mortality rates. While aortic dissections of Type A can be treated surgically today, in the majority of patients with Type B dissections hypotensive treatment is the method of choice, providing a better chance of survival and the effective prevention of aneurysm formation and rupture at the site of the intimal tear. However in certain cases, Type B dissection generates either isthmic aneurysm formation, or, with distal progression, may result in long segmental thoracic, thoraco-abdominal or abdominal deterioration of the aorta and its side branches.

The spinal, visceral, renal and lower limb ischemia threatens the viability of these organs and hypotensive medication may enhance this risk. Emergency diagnostic work-up and selective surgical reconstruction could lead to reduced mortality. In our department we have undertaken 33 thoracoabdominal endoaortectomies with meticulous reconstruction of renal and visceral orifices. The mortality rate in this subgroup of patients was 6%. Based on our experience with Type B aortic dissections we recommend open 舢endoaortectomy” in selected cases in order to improve the long-term outcome.     

覆膜支架主动脉腔内修复术在Stanford B型主动脉夹层中的应用

目的观察覆膜支架主动脉腔内修复术（TEVAR）对Stanford B型主动脉夹层和降主动脉瘤的治疗效果。方法回顾性分析华西医院2013年3～6月采用TEVAR治疗Stanford B型主动脉夹层和降主动脉瘤患者20例的临床资料,其中男19例,女1例;年龄41～76（58．3±10．2）岁,分析其疗效。结果20例患者中,治愈18例,自动出院1例,术后死亡1例。随访满3个月者16例,随访率88．9％。全部随访患者支架范同内真腔管径有所恢复,假腔或瘤腔内血栓形成。结论TEVAR为Stanford B型主动脉瘤提供了一个新的选择,特别是为高龄和合并严重疾病的患者提供了新的治疗手段,优势明显,值得临床应用。