Treatment of acute thoracic aortic injury with commercially available abdominal aortic stent-grafts

Traumatic rupture of the thoracic aorta is a common cause of death after vehicle collisions. Associated injuries are common, and patients with lung injury, cardiac contusion, abdominal bleeding, and head injury comprise a group at high risk for conventional surgical or medical therapy. In this particular population, existing commercially available stent-grafts may provide a life-saving repair option. The Ancure and AneuRx stent-grafts, designed for abdominal aortic aneurysm application, were successfully placed in three patients. Accommodation for the short length of the delivery device was achieved by retroperitoneal iliac artery access. All patients had follow-up computed tomography (CT) without evidence of endoleak and were doing well with respect to their chest trauma after 5-9 months of follow-up.     

Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results

PURPOSE: To evaluate the feasibility and safety of endovascular stent-graft placement in treating Stanford type B aortic dissection. MATERIALS AND METHODS: Seven patients underwent endovascular stent-graft placement for type B aortic dissection. Five patients had acute and two had chronic dissection. In five patients, the proximal entry tear was within 2 cm of the origin of the left subclavian artery, and in two patients it was beyond this site. In three patients, the noncovered proximal portion of the stent-graft was placed across the origin of the left subclavian artery. The efficacy of the procedure was assessed at follow-up studies 3, 6, 12, and 24 months after intervention. RESULTS: The procedure was technically and clinically successful in six patients (86%). The left subclavian artery remained patent in all patients. In two patients with involvement of aortic branches, endovascular stent-graft placement restored adequate blood flow to the compromised branches. One patient was readmitted 1 month later because the dissection extended into the ascending aorta. In all but this patient, closure of the entry tear and thrombosis of the false lumen along the stent-graft were achieved. All false lumina shrank considerably. The mean follow-up time was 14 months (range, 1-25 months). CONCLUSION: Type B aortic dissections within and beyond 2 cm of the origin of the left subclavian artery can be treated safely and effectively by means of endovascular stent-graft placement.     

Stanford B型主动脉夹层腔内修复术学习曲线分析

目的 探讨介入医师对Stanford B型主动脉夹层患者实施胸主动脉夹层腔内修复术(TEVAR)的学习曲线.方法 回顾性分析10年间由同一组介入医师完成的70例B型主动脉夹层TEVAR术,按手术先后次序分为A、B、C、D、E共5组,每组14例.比较各组手术时间、手术相关并发症、术后住院时间,分析不同阶段手术效果.结果 5组患者年龄、性别、分型、伴高血压、伴糖尿病、吸烟史、假腔最大直径、假腔灌注的内脏动脉及其它疾病特征比较,差异均无统计学意义(P＞0.05).手术时间在A、B组分别为(3.29±0.61)h、(2.87±0.37) h(P＜0.05),在C、D、E组分别为(1.80±0.62)h、(1.74±0.34)h、(1.52±0.39)h (P＞0.05),A、B组手术时间显著长于C、D、E组(P＜0.001).5组患者手术相关并发症发生率差异无统计学意义(P＞0.05),住院时间逐渐缩短,但无统计学意义(P＞0.05).A、B组28例手术分别在6.2年、2年内完成,手术频度分别为每年3.3例、7例;B、C、D组42例手术分别在2.2年、1.2年、0.8年内完成,手术频度分别为每年6.4例、11.7例、17.5例.结论 B型主动脉夹层TEVAR术学习曲线约为28例,介入医师在每年平均4.6例手术频度下完成28例手术后手术时间明显缩短,介入医师团队手术技术明显进步.     

B型主动脉夹层腔内修复治疗的荟萃分析

目的 分析B型主动脉夹层腔内修复治疗的技术成功率、轻微并发症、严重并发症、脑卒中、截瘫等的发生率.方法 系统收集1999年至2009年Medline收录的有关B型主动脉夹层腔内修复治疗文献,通过制定纳入和排除标准,对所得数据进行汇总分析.结果 在收录的12篇文献中,共有病例数761例,B型主动脉夹层腔内修复治疗的技术成...     

Stanford B型主动脉夹层多型支架介入治疗的临床体会

目的 应用多种类型支架行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 回颐性分析2004年5月-2009年12月,18例Stanford B型主动脉夹层患者行介入性腔内修复术治疗的临床资料.根据CTA和DSA结果,个体化选择合适覆膜支架,透视下将覆膜支架经股动脉导入封闭夹层破口.术后CTA随访观察内漏、支架移位、假腔变化等.结果 18例中2例放置分体式主动脉覆膜支架、1例放置分支型覆膜支架、2例放置预留孔型主动脉覆膜支架,13例放置普通主动脉覆膜支架.1例封堵左锁骨下动脉、2例不全封堵左锁骨下动脉均未出现左上肢和椎基底动脉缺血症状;1例因解剖变异右锁骨下动脉起自主动脉弓而行旁路手术.术后发生8例(44.4%)即刻I型内漏,其中1例腔内修复术后持续I型内漏再次放置支架后进展为Standford A型主动脉夹层瘤而行升主动脉人工血管置换术,其余CTA随访内漏逐渐消失;所有患者均无支架移位、断裂、塌陷以及术后截瘫及脑血管意外发生.结论 采取不同方法延长近端锚定区的距离、应用分体式主动脉支架可扩大介入治疗Standflord B 型主动脉夹层的适应证,且近期疗效好,中、远期疗效有待进一步观察.     

Endovascular repair of growing chronic type B aortic dissection with a vascular plug

We report the successful endovascular repair of a growing chronic type B aortic dissection using an Amplatzer Vascular Plug II. A 44-year-old man, with previous medical history of aortic surgery and stenting complained of vague back pain. An approximately 5-mm entry remained in the stented segment of the aorta on computed tomography (CT). Endovascular closure of the entry with a Vascular Plug was uneventful. A 3-month follow-up CT showed no leak, complete false lumen thrombosis in the thoracic segment, shrinkage of the false lumen, and a reduced diameter of thoracic aorta.     

腔内修复或药物治疗稳定型B型主动脉夹层

目的 比较胸主动脉腔内修复术(TEVAR)联合药物及单纯药物在稳定型Standford B型主动脉夹层治疗中的价值,探讨稳定型B型主动脉夹层治疗策略.方法 回顾性分析2004年至2015年收治的118例明确诊断为稳定型B型主动脉夹层患者临床资料,其中接受TEVAR联合药物治疗(TEVAR组)57例,单纯药物治疗(药物组)61例.分别统计1个月内、随访期并发症和死亡率,Kaplan-Meier生存曲线比较两组生存率.结果 术后1个月内及住院期间主要并发症发生率、死亡率,TEVAR组分别为5.2％、0％,药物组均为0％.术后随访1～110个月,平均(43.3±36.7)个月,主要并发症、死亡率在TEVAR组分别为7.0％、5.3％,药物组分别为6.6％、8.1％;术后1、2、4、7年累积生存率在TEVAR组分别为100％、97.1％、93.5％、78.0％,药物组分别为98.4％、96.4％、90.8％、72.7％,两组间差异无统计学意义(x2=0.019,P=0.890).结论 与单纯药物治疗相比,TEVAR术治疗稳定型Standford B型主动脉夹层可降低假腔扩展率,但有手术相关并发症,并不能提高生存率.     

腔内修复术治疗复杂型Stanford B型急性主动脉夹层疗效分析

目的探讨腔内修复术治疗复杂型Stanford B型急性主动脉夹层(AAD)的安全性及有效性。方法回顾性分析自2002年4月至2016年2月于沈阳军区总医院心血管内科行腔内修复术治疗的99例复杂型急性Stanford B型AAD患者的临床资料,并分析其围术期特点及近、远期疗效。结果 99例患者均经腔内修复术治疗,98例成功植入支架,共植入支架104枚,其中,94例患者植入单支架,5例患者植入双支架。合并冠心病26例(26.3%),其中,7例(7.1%)合并严重冠状动脉狭窄,行经皮冠状动脉介入治疗,共植入冠状动脉支架8枚。7例(7.1%)患者在院死亡。在院期间无截瘫、脑卒中等并发症发生。77例患者获得随访,中位随访时间24个月。随访期间,9例(11.7%)患者死亡,其中,4例(5.2%)患者死于主动脉源性。1例(1.3%)患者因再发夹层再次行腔内修复术治疗。结论复杂型Stanford B型AAD病情凶险,预后差,应积极控制血压,进行主动脉腔内修复术治疗有利于降低病死率,有利于改善近远期预后,安全可行。     

85例Stanford B型主动脉夹层腔内修复治疗体会

目的 探讨胸主动脉腔内修复术(TEVAR)治疗Stanford B型主动脉夹层(AD)方法与疗效.方法 回顾性分析2010年1月至2016年4月采用TEVAR治疗的85例Stanford B型AD患者临床资料.85例患者均常规行左肱动脉穿刺,右侧股动脉直切口,升主动脉DSA造影明确AD破口位置、真假腔及与重要器官血管开口位置关系;置入覆膜血管内支架,封堵原发破口,升主动脉造影复查观察近端破口封闭情况及主动脉弓部分支血管、真假腔血流变化情况.结果 84例患者TEVAR手术成功,成功率100％;1例术前麻醉过程中突发AD破裂死亡.9例部分覆盖左锁骨下动脉,1例左锁骨下动脉“烟囱”支架完全封闭左颈总动脉和左锁骨下动脉,2例行无名动脉至左颈总动脉和左锁骨下动脉转流.Ⅰ型内漏2例,无住院期间死亡.术后随访3个月至3年,患者均存活,远端再发新破口2例.结论 TEVAR术治疗Stanford B型AD安全有效,严格把握手术指征、术中精细操作及加强术后院外管理是手术成功、提高远期生存率关键.     

Endovascular treatment of ureteroarterial fistulas with stent-grafts

Ureteroarterial fistula is a rare condition with life-threatening hematuria that should be diagnosed and treated immediately. We reported two patients of ureteroarterial fistula who underwent successful endovascular treatment by stent-grafts. They had undergone pelvic surgery followed by placement of an indwelling ureteral stent for stricture of the ureter before sudden hematuria occurred. Routine contrast-enhanced computed tomography did not reveal extravasation or a pseudo-aneurysm. Angiograms with multiple oblique views demonstrated small pseudoaneurysms of the iliac artery overriding the ipsilateral ureter. The endovascular treatment of ureteroarterial fistula using stent-grafts was successful, and the hematuria disappeared immediately after stent-graft deployment. The hematuria did not recur up to the last follow-up visits of 3 and 19 months, respectively.     

右位主动脉弓伴DeBakey Ⅲ型主动脉夹层的腔内修复治疗一例

患者男,65岁,突发性胸痛5 d,加重8 h,于2008年2月19日急诊入院.入院体检:血压147/70 mm Hg(1mm Hg=1.333 kPa).CTA示主动脉夹层动脉瘤,病变起始于主动脉弓降部,止于左肾动脉下方15 mm;右位主动脉弓及胸主动脉,主动脉弓分支由近心端向远心端依次为左颈总Kommerell憩窜的迷走左锁骨下动脉,腹腔干、肠系膜上动脉、右肾动脉开口于腹主动脉真腔,左肾动脉骑跨于腹主动脉真假腔,降主动脉夹层动脉瘤最大径92.2 mm,两侧胸腔少量胸水     

Stanford B型主动脉夹层治疗进展北大核心CSCD

近年来主动脉夹层(AD)发病率和检出率日益增高,临床上越来越引起重视。随着介入技术日益发展,血管腔内治疗已成为AD主要治疗方法之一。研究发现,存在AD远端破口是影响胸主动脉腔内修复术中远期疗效的重要因素之一。该文从AD流行病学表现、分期分型、基础治疗和介入治疗方式进行综述分析,并就Stanford B型AD远端破口治疗研究进展作一总结,为临床术式决策提供可行参考。     

血管腔内隔绝术治疗降主动脉夹层动脉瘤

目的：探讨血管腔内隔绝术治疗降主动脉夹层动脉瘤的技术方法和疗效。方法：对10例降主动脉夹层动脉瘤患者的临床资料进行分析,其中2例为DeBakeyШa型,8例为DeBakeyШb型。1例夹层动脉瘤仅累及腹主动脉,合并真性动脉瘤。影像学资料显示全组有3例在不同部位有2个以上撕裂口。结果：1例腹主动脉混合型动脉瘤按腹主动脉瘤腔内隔绝术进行,2例将人工带膜支架封闭左锁骨下动脉口,另7例均顺利进行主动脉腔内隔绝术。随访2~16个月,全部病例均存活。结论：血管腔内置入带膜支架型人工血管是治疗主动脉夹层动脉瘤的简便、安全、有效的方法。     

Stanford B型主动脉夹层腔内修复术治疗体会

目的:探讨腔内修复术治疗Stanford B型主动脉夹层的效果。方法:对2005-09~2010-02期间18例Stanford B型主动脉夹层患者实行血管造影和血管腔内带膜支架植入手术治疗,术后3、6、12个月行CTA检查,观察手术疗效以及有无狭窄、移位和扭曲等术后并发症。结果:无中转开胸手术。除1例再发Stanford A型夹层破裂死亡外,其余患者均顺利出院。结论:主动脉夹层腔内修复术治疗Stanford B型主动脉夹层是一种安全有效的方法,早期结果满意,中远期效果还有待观察。     

急性期Stanford B型主动脉夹层腔内治疗研究进展

随着胸主动脉腔内修复术（TEVAR）的广泛应用及迅速发展,腔内治疗已成为了Stanford B型主动脉夹层的一线治疗方法。腔内治疗主动脉夹层的预后除了依赖于术前个体化方案的制定和术中操作者的经验,更依赖于手术指征及时机的掌握。对于急性期复杂性B型夹层,提倡在药物治疗的基础上早期行TEVAR手术;对于急性期非复杂性B型夹层是否可行TEVAR手术仍存在争议。文章主要就急性期B型主动脉夹层行腔内治疗的研究进展进行综述。