血管腔内修复术治疗StanfordB型主动脉夹层83例

目的总结血管腔内治疗StanfordB型主动脉夹层的经验。方法对我院腔内治疗的83例StanfordB型主动脉夹层的临床资料进行回顾性分析。结果全组病例均手术成功,2例围术期死亡,1例术后昏迷,无截瘫发生。结论血管腔内修复术治疗StanfordB型主动脉夹层具有微创、安全、有效的优点,远期疗效尚需长期随访。     

覆膜支架腔内隔绝术治疗Stanford B型主动脉夹层19例

目的应用主动脉覆膜支架行Stanford B型主动脉夹层介入治疗,探讨扩大介入治疗适应证的可行性。方法分析2006年4月至2010年11月19例Stanford B型主动脉夹层患者行主动脉腔内修复术治疗的临床资料,根据多排螺旋CT血管成像(CTA)和数字减影血管造影(DSA)结果,选择个体化主动脉覆膜支架介入治疗,术后随访观察内漏、支架位置、假腔变化及脏器供血等。结果置入即刻造影示15例破口完全封堵,2例近端有中量内瘘,经用球囊扩张近端支架后内瘘明显减少,1例少量内瘘不需处理。2例破口距左锁骨下动脉小于0.5 cm者覆膜支架均完全封堵左锁骨下动脉,无脑及左上肢缺血表现。结论应用主动脉覆膜支架行Stanford B型主动脉夹层介入治疗安全、效果可靠,采用不同方法延长近端锚定距离,可扩大介入治疗Stanford B型主动脉夹层适应证。     

覆膜血管内支架治疗Stanford B型主动脉夹层36例临床分析

目的观察覆膜血管内支架治疗StanfordB型主动脉夹层的方法和临床疗效。方法对2007年3月至2011年10月36例StanfordB型主动脉夹层实施覆膜血管内支架治疗患者的临床资料进行回顾性分析。结果本组36例腔内隔绝术均获成功。1例术后造影显示出现轻微内漏,3个月后复查显示内漏消失;1例术中部分封闭左锁骨下动脉开口;1例术前并发脑梗死的患者术后经高压氧治疗后痊愈;1例术后并发肺部感染,经气管切开及呼吸机辅助呼吸等治疗后痊愈。全组无死亡病例,无截瘫、器官缺血、血栓形成等相关并发症发生。29例术后获随访3～24个月,复查主动脉CT显示夹层真腔明显增大,假腔明显缩小,覆膜支架位置、形态保持正常,无支架移位及内漏。结论覆膜血管内支架治疗StanfordB型主动脉夹层具有安全、有效、创伤小、严重并发症少等优势,近期疗效令人满意,远期疗效还有待更长的随访。     

腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤20例

主动脉夹层瘤是临床较常见的动脉扩张性疾病,发病危急,预后极差。据报道,50%患者死于48小时,70%死于l周内,每小时的死亡危险为1%[1]。自1994年Dake等报道以微创腔内隔绝术(endovascular graft exclusion,EVGE)治疗Stanford B型主动脉夹层瘤以来,其应用不断拓展。我院近年来行EV     

胸主动脉腔内修复术治疗Stanford B型主动脉夹层的长期疗效

目的 观察胸主动脉腔内修复术(TEVAR)在Stanford B型主动脉夹层治疗中的应用效果及其长期疗效.方法 回顾性选取2016年3月至2019年3月文山州人民医院收治的100例Stand ford B型主动脉夹层患者为观察对象,按照治疗方法不同将其分为对照组(n=50)与治疗组(n=50),对照组予以患者传统开放式...     

杂交手术室行Stanford B型主动脉夹层腔内修复术122例护理配合

目的:探讨杂交手术室行Stanford B型主动脉夹层腔内修复术患者的护理配合方法。方法:对122例杂交手术室行Stanford B型主动脉夹层腔内修复术患者给予精心围术期护理配合。结果:本组手术均顺利完成,术后CTA随访证实所有病例夹层破口完全封闭,假腔内血栓形成。结论:利用杂交手术室的优势,配备高素质专业护理人员,做好术前、术中护理配合是手术成功的重要保证。     

带膜支架血管腔内隔绝术治疗急性Stanford B型主动脉夹层2例

我院于2004年5月至7月期间连续行2例带膜支架血管腔内隔绝术治疗急性Stanford B型主动脉夹层。现就其初步治疗经验介绍如下。     

Stanford B型主动脉夹层腔内治疗的血流动力学研究进展

主动脉夹层起病急,死亡率高,目前主动脉夹层腔内修复术已成为Stanford B型夹层的主要治疗手段。虽然主动脉夹层腔内修复术明显降低了手术并发症发生率及死亡率,但对累及重要分支血管的主动脉夹层,单纯的覆膜支架隔绝夹层破口并不能满足临床需求,因此杂交手术、烟囱技术、开窗技术及分支支架技术应运而生。本文结合血流动力学因素,对目前主动脉夹层的腔内修复术作一综述,为临床选择合适的治疗方式提供参考。     

胸主动脉内修复术治疗复杂型Stanford B型主动脉夹层疗效观察

目的 探讨复杂型Stanford B型主动脉夹层患者采用胸主动脉内修复术治疗的临床效果及安全性。方法 复杂型Stanford B型主动脉夹层患者118例,均行胸主动脉内修复术,观察手术情况、住院时间、ICU治疗时间及围手术期并发症发生情况,术后随访3年,记录患者随访第1、3年时生存情况。结果 118例患者均顺利完成手术,住院时间(17.58±11.05)d, ICU治疗时间(11.14±5.99)d, 2例分别于术后第2、7天因心源性休克死亡。围手术期发生急性肾功能不全10例,肠道缺血10例,下肢缺血8例,新发脑卒中9例,胸腔积液15例,肺部感染30例;术后随访1年时,新发夹层4例,均行二次干预;生存111例(94.1%),死亡7例(5.9%),其中主动脉源性死亡5例,心源性死亡1例,脑源性死亡1例。随访3年时,新发夹层8例,支架近/远端动脉瘤2例,均行二次干预;生存104例(88.1%),死亡14例(11.9%),其中主动脉源性死亡7例,心源性死亡3例,脑源性死亡2例,其他原因死亡2例。结论 胸主动脉内修复术是一种治疗复杂型Stanford B型主动脉夹层安全、有效的治疗方式,近中期...     

腔内隔绝术治疗Stanford B型胸主动脉夹层21例

目的:探讨应用覆膜支架行腔内隔绝术治疗Stanford B型主动脉夹层的临床效果.方法:21例Stanford B型主动脉夹层患者均应用覆膜支架行腔内主动脉隔绝术.结果:本组21例覆膜支架均成功释放,1例覆膜支架覆盖左侧锁骨下动脉开口引起术中深昏迷,急行双侧腋-腋动脉人工血管搭桥后神志恢复,术后2周CT血管造影复查显示...     

DeBakeym型主动脉夹层腔内修复治疗并发症的处理与分析

目的总结近年来我科DeBakey III型主动脉夹层腔内修复治疗的经验,重点探讨围术期发生的并发症及其预防与处理。方法回顾性分析自2009年1月至2011年1月的2年间我科完成49例DeBakey III型主动脉夹层腔内修复治疗患者的临床资料。结果无术后近期死亡、无截瘫。严重的并发症有昏迷2例（4．1％）、内漏2例（4．1％）、上肢缺血2例（4．1％）。新发近端夹层1例。术后多数患者存在不同程度发热。结论腔内修复治疗能够降低夹层治疗的病死率,但严重并发症不容忽视。降低逆行性夹层、急性脑供血不足、内漏等并发症可以进一步改善患者的预后,提高生存质量。     

超声在StandordB型主动脉夹层腔内隔绝术中初步应用体会

现将我科配合我院血管外科中心进行6例腔内隔绝术(endovascular graft exclusion,EVGE)中经食管超声心动图(TEE)的初步应用体会作一报道.     

烟囱技术重建与单纯封闭左锁骨下动脉在主动脉夹层腔内治疗中的疗效比较

目的 比较烟囱技术重建与单纯封闭左锁骨下动脉在近端锚定区不足主动脉夹层腔内治疗中的疗效.方法 对2016年1月至2019年3月在山东省菏泽市立医院接受主动脉腔内修复术治疗的56例近端锚定区不足主动脉夹层患者进行回顾性研究,根据左锁骨下动脉处理方式的不同分为烟囱重建组26例和单纯封闭组30例.烟囱重建组术中将主体支架封闭...     

Acute type B aortic dissection: update on proper management

This study aims to collect and present all current literature data on the diagnostic and therapeutic management of acute type B aortic dissection. It includes a comprehensive literature search utilizing the following keywords: ‘acute aortic dissection’, ‘type B aortic dissection’, ‘conservative management’, ‘endovascular repair’, ‘open surgery’ and ‘diagnosis’. Uncomplicated acute type B aortic dissection can be effectively managed using conservative management, although open repair is indicated only for complicated cases. Endovascular repair shows promising results in selected patients with increased perioperative risk and without contraindications. Recent evidence supports endovascular repair even in uncomplicated cases, although more data on long-term outcomes are needed. Early risk stratification and evaluation of the patient is crucial for selection of optimal management.     

Thoracic endovascular aortic repair versus open chest surgical repair for patients with type B aortic dissection: a systematic review and meta-analysis

Abstract

Aim: This meta-analysis study aimed to compare the efficacy and safety of TEVAR versus OCSR for TBAD patients.

Methods: We systematically searched PubMed, EmBase, and the Cochrane library to identify studies compared the effectiveness of TEVAR and OCSR in TBAD patients from the inception up to July 2019. The summary results were calculated using a random-effects model.

Results: The electronic search identified 1,894 studies, and 18 studies with 9,664 TBAD patients were included. We noted patients received TEVAR were associated with a reduced risk of in-hospital mortality, acute renal failure, respiratory failure, and bleeding as compared with OCSR, whereas no significant differences between groups for the risk of stroke, myocardial infarction, paraplegia, mesenteric ischaemia/infarction, reinterventions, sepsis, and spinal cord ischaemia.

Conclusions: The findings of this meta-analysis study suggested that TEVAR resulted in more short-term survival benefits. Moreover, the reduced risk of acute renal failure, respiratory failure and bleeding was detected in TEVAR group. The treatment effects of TEVAR versus OCSR on specific complications should be further verified by a study with high-level of evidence.

• Key message

• Comprehensive collected studies investigated the treatment effectiveness between TEVAR and OCSR for TBAD patients

• TEVAR resulted in more survival benefits, in addition to lower risk of acute renal failure, respiratory failure and bleeding

• The results of stratified analyses according to patients’ characteristics were conducted

     

去分支技术联合腔内修复治疗复杂型StanfordB型主动脉夹层的疗效及预后分析

目的研究去分支技术联合腔内修复技术治疗复杂型Stanford B型主动脉夹层的疗效及预后。方法选择2011年8月至2014年7月我院收治的43例复杂型Stanford B型主动脉夹层患者进行研究。给予所有患者一般治疗,然后再给予去分支技术联合腔内修复治疗。观察患者在术中的情况,包括死亡情况、病死率、住院时间,在术后进行为期3年的随访,对患者的随访情况进行统计,主要包括并发症和死亡情况。结果 43例患者在住院期间的病死率为4.65%(2/43),住院时间为(18.32±8.2)d。在术后进行为期3年的随访,所有患者中没有肾功能不全、偏瘫、截瘫现象出现,在3年期间总的死亡率为4.65%(2/43),其总体死亡率较低。结论去分支技术联合腔内修复技术治疗复杂型Stanford B型主动脉夹层,其疗效良好,明显提高了患者的近、中期生存率,有利于患者预后,值得广泛推广使用。     

Total endovascular repair of an intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection: A case report

BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.