胸主动脉夹层动脉瘤血管内支架介入治疗

目的探讨腔内隔绝术（EVGE）治疗胸主动脉夹层动脉瘤（TAD）的技术和方法。资料与方法TAD55例,支架为记忆合金自膨支架和超薄涤纶人工血管的复合体,直径根据螺旋CT血管造影（CTA）和主动脉数字减影血管造影（DSA）确定。在DSA引导下沿导丝经真腔将该复合体封闭内膜破口和假腔。结果55例共置入63个支架,其中置入1个支架48例,2个支架6例,3个支架1例。内漏9例。术中死亡1例,54例术后康复良好。手术后CT随访。结论术前准确影像学评价,选择适当口径、长度的支架和术中准确定位夹层裂口和正确判断夹层真、假腔是EVGE治疗成功的关键。肠系膜上动脉、肾动脉受累并不是绝对禁忌症。EVGE创伤小,安全度高,是当前治疗TAD的新颖、高效、首选的介入治疗方法。     

血管覆膜支架置入治疗胸主动脉夹层动脉瘤

目的:介绍覆膜支架血管内置入治疗胸主动脉夹层动脉瘤(TADA)的初步经验。方法:本组4例Debakey B型胸主动脉夹层动脉瘤,经CT或MR增强检查确诊。经股动脉置入覆膜支架,封堵胸主动脉破裂口,置入后造影检查证实疗效,术后随访采用彩超或增强CT检查。结果:4例患者共成功置入7个支架,1例术后支架远端出现内漏,6个月后内漏自行封闭;1例并发的腹主动脉瘤随访2个月无变化;随访2~18个月,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。结论:覆膜支架血管内置入治疗胸主动脉夹层动脉瘤的近期疗效满意。     

带膜支架腔内置入术治疗急性胸腹主动脉夹层

目的 :探讨带膜支架腔内置入术治疗急性胸腹主动脉夹层的应用和疗效。方法 :对 1例急性胸腹主动脉多发破口的主动脉夹层采用带膜支架置入治疗 ,并分析其疗效。结果 :经股动脉置入两枚带膜支架封闭破口成功 ,术后复查彩超和多层螺旋CT示主动脉夹层消失 ,假腔内血栓形成 ,未出现支架移位、狭窄等并发症。结论 :带膜支架腔内置入术是治疗主动脉夹层的有效方法。     

应用国产覆膜支架治疗Stanford B型主动脉夹层动脉瘤

目的:评价应用国产覆膜支架治疗B型主动脉夹层动脉瘤的安全性及临床疗效.方法:自2005 - 05～2009 - 12对38例Stanford B型主动脉夹层动脉瘤实施了腔内隔绝术.其中男29例,女9例;年龄(54±12)岁.经CT增强扫描或磁共振成像(MRJ)确诊.切开左或右股动脉置入覆膜支架,封堵胸主动脉破裂口,置入后造影检查证实疗效,随访行CT或MRI检查.结果:支架置入全部成功,术后即刻造影36例无内漏,2例见少量内漏.降主动脉及腹主动脉真腔均明显扩大,远端降主动脉及分支供血均有不同程度改善.住院期间及随访1年内无患者死亡,发生主动脉腔内隔绝术后综合征3例.结论:应用国产覆膜支架腔内隔绝治疗B型主动脉夹层动脉瘤是一种操作简便、安全、成功率高、并发症少,疗效可靠的介入方法.     

主动脉夹层动脉瘤的血管内支架治疗

目的评价血管内支架置入治疗主动脉夹层动脉瘤的安全性和临床疗效。方法48例Stanford B型主动脉夹层动脉瘤患者行腔内修复术。所有患者在DSA下行左肱动脉穿刺插管、造影,了解主动脉真、假腔,夹层裂口及其与重要血管分支位置关系。腹股沟区纵切口显露股动脉,送入人工血管输送器至病变处,准确定位后,释放人工血管进行腔内修复。术后复查造影,观察真、假腔血液动力学变化,内脏及下肢动脉供血的改变。结果48例患者一次性成功置入人工血管支架,2例支架未能完全封堵漏口,内漏明显,手术成功率95.8%。支架置入后假腔血压下降,机体脏器缺血状况改善,临床症状好转或消失。结论支架性人工血管腔内修复术治疗主动脉夹层动脉瘤安全可行、效果明显,值得临床进一步推广。     

带膜血管内支架置入治疗主动脉夹层动脉瘤患者的护理

主动脉夹层动脉瘤是心脏大血管急症.起病突然,常有剧烈疼痛、休克和压迫症状,同时伴有心血管系统、胃肠道系统、泌尿系统、神经系统等多器官损害,其病死率于发病后24 h内为21%.若治疗不及时或护理不当,半数以上在2周内病死.近年来,通过血管腔内技术用支架型人工血管治疗主动脉瘤已倍受推崇.2002年8月至2004年4月,我院采用经股动脉覆膜支架置入术治疗胸主动脉夹层动脉瘤患者16例,效果好,创伤小,安全性高,术后恢复快.现将护理体会报告如下.     

带膜支架治疗Stanford B型胸主动脉夹层的经验探讨

目的:探讨Stanford B型胸主动脉夹层(TAD)腔内隔绝术一些经验.方法:回顾性分析我院2002年～2005年全麻下行腔内隔绝术的36例Stanford B型胸主动脉夹层患者的资料.结果:所有患者均成功实行了带膜支架腔内隔绝术,未出现死亡现象,内漏9例,右股动脉切开处内膜撕裂3例.结论:带膜支架置入术治疗Stanford B型胸主动脉夹层是一种安全有效的方法,但术中术后并发症的预防是成功的关键.     

带膜支架治疗Stanford B型胸主动脉夹层的疗效分析

目的分析带膜支架腔内隔绝术治疗Stanford B型胸主动脉夹层的短期和中长期疗效。方法对2005年1月至2013年12月全麻下行带膜支架治疗的183例Stanford B型胸主动脉夹层患者的资料进行回顾性分析,包括术后住院期间的临床症状、术后并发症、ICU留观时间、住院时间、30 d病死率、出院后复查支架塌陷情况、位置和形态、夹层假腔直径情况、内漏等并发症及生存率、生存质量等。结果 183例患者带膜支架腔内隔绝术手术均成功,术后平均ICU留观时间为(3.08±1.93)d,平均住院时间为(7.08±1.67)d,术后30 d病死率为1.09%;出院后定期影像学复查所有患者均无支架塌陷、移位,形态正常,未出现夹层复发、破裂和逆向撕裂,未发现长期存在的内漏。随访过程中死亡4例,其中3例诊断为脑梗死。患者5年生存率为97.82%,生存质量无明显下降。结论腔内隔绝术治疗Stanford B型胸主动脉夹层具有良好的短期疗效和稳定的中长期疗效。     

覆膜支架治疗降胸主动脉瘤

目的评估覆膜支架治疗术治疗Stanford B型主动脉夹层和降主动脉瘤的安全性和近期疗效。方法2003年3月至2005年9月期间,共29例Stanford B型主动脉夹层和2例降胸主动脉瘤患者接受覆膜支架治疗术,所有患者均有高血压病史,其中急性发病27例.本组采用两种支架(Mdtronic Talent15例,上海微创Aegis 16例),术后采用CTA进行定期随访。结果所有支架均成功按预期定位释放,术后即刻DSA复查显示23例夹层患者近端破裂口完全封闭,2例降主动脉瘤也完全隔离,6例发现有内漏;术后7 d CTA复查发现16例假腔内完全血栓形成,12例近端假腔形成血栓,远端假腔仍开放。结论覆膜支架术治疗Stanford B型主动脉夹层和降主动脉瘤安全、有效,可替代外科手术。但覆膜支架术的确切长期疗效尚待进一步的大样本、前瞻性对照研究才能确定。     

主动脉夹层动脉瘤1例行内支架围手术期护理

主动脉夹层动脉瘤又叫主动脉夹层血肿,是指循环血液渗入主动脉夹层形成的一种致病性疾病,急性发病主要以胸痛、腹痛,伴休克和高血压为主,如果瘤体破裂即可导致患者死亡。我院于2008-09成功地为1例主动脉夹层动脉瘤患者实施了内支架腔内隔绝术,现报告如下。1病例介绍     

16层螺旋CTA术前评估主动脉夹层及动脉瘤腔内隔绝术的价值

目的:探讨16层螺旋CT血管成像(16-MSCTA)在主动脉夹层和腹主动脉瘤腔内带膜支架置入术前评估中的价值.方法:40例主动脉夹层和腹主动脉瘤患者术前行16层螺旋CT血管成像检查.采用层面准值16×0.75,螺距1,重建层厚1 mm,间隔0.7 mm;碘对比剂总量按患者体重计算,CTA延迟扫描时间用小剂量对比剂试验法测定;重点运用专用软件测量主动脉夹层及动脉瘤腔内带膜支架置入术所需的所有参数.结果:Ⅲ型夹层26例,单个破口23例,多个破口3例.其中8例符合腔内隔绝术;腹主动脉瘤14例,其中4例符合腔内隔绝术.16-MSCTA提示腹主动脉瘤合并动脉粥样硬化改变11例,与病理诊断结果一致(100%).结论:16-MSCTA可从局部到整体对瘤体进行多方位的观察和测量,提供腔内隔绝术所需的各项参数,为主动脉夹层和腹主动脉瘤选择治疗方案以及术前规划提供更多的信息.     

主动脉夹层或瘤的腔内隔绝术临床评价(附23例报道)

目的:评价应用腔内血管支架治疗腹主动脉瘤的优点。方法:对24例患者行DSA和带膜血管腔内支架植入隔绝手术治疗,其中Stanford B型夹层动脉瘤19例,真性腹主动脉瘤4例,假性腹主动脉瘤1例。所有病例均采用TALENTTM带膜支架移植物系统。术后对所有患者行螺旋CT随访。结果:除1例因胸主动脉夹层破口位于左锁骨下动脉开口处,无法放置腔内血管支架而行开胸手术外,余23例均顺利放入,术后患者症状完全消失,全部患者在随访期间均未出现术前症状,未见相关并发症。结论:应用带膜支架治疗胸主动脉Stanford B型夹层、真性和假性腹主动脉瘤,其效果较单纯开放式手术效果好且不良反应小,值得在临床上推广和应用。     

Matrix可脱弹簧圈栓塞治疗颅内动脉瘤的临床应用

目的探讨Matrix可脱弹簧圈血管内栓塞治疗颅内动脉瘤的临床价值。方法对56例共61个颅内动脉瘤施行血管内Matrix可脱弹簧圈栓塞治疗,4例宽颈动脉瘤和2例梭形动脉瘤采用Neuroform支架结合Matrix可脱弹簧圈栓塞治疗。结果应用Matrix可脱弹簧圈栓塞成功53例58个动脉瘤,占95.1%;3例因严重血管痉挛导致微导管无法到位而实施动脉瘤夹闭术;2例弹簧圈尾端残留于载瘤动脉,但未导致临床后果;无死亡及严重并发症;53例随访3～12个月无再次出血和并发症。结论Matrix可脱弹簧圈可有效栓塞颅内各部位动脉瘤,术中有明显的促进动脉瘤腔内形成血栓的作用,可以防止再次破裂出血。     

Stent-graft repair of thoracic aortic aneurysms

Endovascular treatment of aortic disease has emerged as an alternative mode of treatment that is particularly attractive for patients with severe comorbidities who would not be ideal candidates for open surgery. Actually, short-term morbidity and mortality rates, of large series, compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases. However, although endoluminal interventions are minimally invasive, they are associated with complications, as are surgical methods. In this article, indications, technical aspects, and results of endovascular TAA repairs will be reviewed. We will also examine the advantages and limitations of stent-graft treatment. Finally, we will discuss the management of complications following aortic stent-graft implantation. We intentionally do not cover the topic of thoracic dissection, as it is being covered in another article in this volume.     

髂动脉粥样硬化狭窄的支架植入治疗

目的探讨髂动脉粥样硬化狭窄的支架植入治疗的安全性和疗效。方法髂动脉粥样硬化狭窄患者15例,病变长度4.3~9.5 cm,平均6.7 cm,间歇性跛行间距100~300 m。应用大剂量局部溶栓 支架成形术(PTAS)治疗。术后追踪采用动脉彩超或16层CT以及踝肱指数(AB I)。结果本组支架植入治疗的技术成功率为100%,术后患者的症状和体征明显改善,AB I由术前的0.25±0.18增至术后14 d的0.85±0.15(P=0.00)。随访3~47个月,其中1例男性高龄患者于治疗3个月后,因脑干血栓死亡,其余患者均健在,无1例出现再狭窄及闭塞。11例患者跛行症状消失,3例患者跛行间距>1000 m。结论髂动脉粥样硬化狭窄的支架植入治疗的近、远期疗效满意,安全可靠。     

Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1–84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs ≥18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs ≥18 mm (p = 0.232). One-year freedom from IRSI was 92% ± 3% and 84% ± 9% for the <18-mm and ≥18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18–24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.     

血管内支架置入术治疗Stanford B 型主动脉夹层

目的：总结主动脉血管支架置入术治疗Stanford B型主动脉夹层的临床经验。方法：术前对15例Stanford B型主动脉夹层患者进行主动脉全程薄层增强CT扫描及血管成像,以获得主动脉夹层病变解剖学特征。在局麻下行主动脉造影,并与CT结果比较,选取支架血管型号。全麻下切开左股动脉或右股动脉,置入支架血管,封堵原发破口,重复造影检查有无内漏。术后1周及1年行CT随访,观察有无内漏、支架移位和假腔变化。结果：15例均获临床成功。1例见少量近端内漏,未发生其他并发症。CT随访,5例主动脉夹层消失,余者假腔内血栓形成。结论：与传统手术相比,腔内隔绝术治疗Stanford B型主动脉夹层具有创伤小、并发症少、安全性高等优点,近期疗效满意。     

Endovascular Treatment of Ruptured Iliac Aneurysm Previously Treated by Endovascular Means

A patient with a ruptured iliac aneurysm was admitted to the Emergency Department in hypovolemic shock. He had previously undergone surgical treatment for an infrarenal abdominal aortic aneurysm, which was managed with a terminal-terminal Dacron tube graft. Subsequently, he developed two iliac aneurysms, which were treated endovascularly with two wall-grafts in the right and one wall-graft in the left iliac arteries. He suffered chronic renal failure and arterial hypertension. Contrast-enhanced computed tomography showed rupture of the right iliac aneurysm and dislocation of the two wall-grafts. He was treated in an emergency situation with the implantation of an iliac endograft that bridged the two wall-grafts, which resulted in hemostasis and stabilization of his condition. Five days later, in an elective surgical situation, he was treated with the implantation of an aorto-uni-iliac endograft combined with a femoral-femoral bypass. He was discharged 5 days later in good condition. At the 4 year follow-up visit, the endoprosthesis remained in place with no evidence of an endoleak. In conclusion, overlapping of endografts should be avoided, if possible. Strict surveillance of the endovascularly treated patient remains mandatory.