血管腔内覆膜支架治疗胸降主动脉瘤

目的探讨覆膜支架治疗急、慢性胸降主动脉瘤的方法及效果。方法对36例胸降主动脉瘤的临床资料作回顾性分析。结果使用覆膜支架36枚,完全封堵动脉内膜破口,真腔血流恢复正常,近期疗效满意。结论使用覆膜支架腔内隔离术治疗胸降主动脉瘤,符合其病理解剖特点,能很好地封闭内膜破口．具有创伤小、适应证宽、治疗效果确切、康复迅速等优点。     

人造血管覆盖支架经皮介入治疗降主动脉夹层八例

目的探讨人造血管覆盖支架经皮介入治疗降主动脉夹层的方法。方法对8例降主动脉夹层(Stanford B型)患者行人造血管覆盖支架经皮的介入治疗。经股动脉将美敦立公司Talent主动脉覆盖支架置于降主动脉夹层裂口处,支架自膨胀张开使人造血管覆盖支架固定于裂口附近的主动脉壁上将裂口封闭并阻断血流进入假腔。结果8例患者均获得成功,手术成功率100%。平均随访6个月,所有患者内膜裂口完全封闭,假腔内血栓形成,无内漏,假腔明显缩小。结论人造血管覆盖支架经皮介入治疗降主动脉夹层方法安全可靠。     

经股动脉植入人造血管覆盖支架治疗B型主动脉夹层动脉瘤——附1例报告

最近 ,我们对 1例病变波及胸腹主动脉且濒临破裂的Ｂ型夹层动脉瘤患者实施了胸主动脉内人造血管覆盖支架植入术 ,成功地闭合了假腔 ,开通了主动脉 ,现报道如下。临床资料患者男性 ,47岁 ,因高血压病、高脂血症 3年、突发剧烈胸背疼痛伴全身大汗 1ｈ入住当地医院 ,经治疗 48ｈ疼痛缓解不理想转来我院 ,经磁共振检查明确诊断为Ｂ型夹层动脉瘤 ,经积极降压、镇痛、镇静及严格限制活动等内科治疗 ,血压控制良好 ,疼痛缓解 ,心肺及肾功能无明显异常 ,入院后第 7天患者因用力大便再次诱发剧烈胸痛并出现低血压 ,体检左侧颈部新出现血管杂音 ,病情…     

主动脉瘤的血管内支架治疗

1991年由Ｐａｒｏｄｉ等[1]首先报告应用血管内支架治疗主动脉瘤获得成功。这是采用由金属丝编成的支架并覆盖人工血管,经导管送入主动脉瘤部位,释放支架血管将动脉瘤与主动脉血流隔离,以达到治疗动脉瘤的目的。7年来,有关支架血管治疗主动脉瘤的实验研究和临床报告不间断地发表,显示这是一个迅速发展的领域。同时,在血管内支架治疗的临床效果被基本确定的情况下,仍存在着一些有待进一步解决的问题。一、支架血管的基本结构和支架放送的基本技术自从Ｐａｒｏｄｉ最初采用Ｐａｌｍａｚ支架(球囊扩张Ｚ型不锈钢支架)用于临床以来,支架经历了多…     

带膜内支架治疗胸主动脉瘤

目的 探寻治疗胸主动脉瘤的新术式。方法 10例胸主动脉瘤病例，其中7例行单纯带膜血管内支架(stent-graft)治疗，3例夹层破裂(De Bakey I)患者行象鼻手术加带膜血管内支架置入术。结果 7例带膜血管内支架治疗组，5例成功，1例失败，1例术后死亡；3例夹层破裂手术病例均成功，恢复顺利，无并发症。结论带膜血管内支架为治疗胸降主动脉瘤的一种有效可靠方法；象鼻手术结合带膜内支架是治疗De BakeyI型的新方式，可降低手术并发症及术后病死率。     

免缝合主动脉移植物在胸主动脉瘤手术中的应用

胸主动脉瘤尤其胸主动脉夹层动脉瘤严重危害患者生命,大多数患者需接受人造血管置换治疗；术中缝合难度大,术后死亡率高。本文就近年来新型免缝合主动脉移植物在胸主动脉瘤术中的应用作一综述。     

免缝合主动脉移植物在胸主动脉瘤手术中的应用

胸主动脉瘤尤其胸主动脉夹层动脉瘤严重危害患者生命,大多数患者需接受人造血管置换治疗;术中缝合难度大,术后死亡率高.本文就近年来新型免缝合主动脉移植物在胸主动脉瘤术中的应用作一综述.     

腔内血管支架植入治疗胸主动脉夹层

目的：总结腔内血管支架植入治疗主动脉夹层临床经验。方法：胸主动脉夹层5例,男3例,女2例,平均年龄(53.5±4.5)岁。经多排 CT 增强扫描或磁共振成像确诊。切开右侧股动脉,植入腔内血管带膜支架,封堵原发破口。植入后重复造影检查。随访行胸部 X 线平片与多排螺旋 CT 检查。结果：支架植入均成功,术后即刻造影5例均无内漏。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明显改善。术后3月随访,降主动脉及腹主动脉真腔扩大,近端夹层动脉瘤消失。结论：腔内血管带膜支架植入治疗胸主动脉夹层近期疗效满意。     

12例胸主动脉瘤的外科治疗

目的报告12例胸主动脉瘤的外科治疗经验。方法对我院自1998年4月至2003年8月完成的12例胸主动脉瘤外科治疗方面的经验进行总结。5例动脉硬化性升主动脉瘤和2例马凡综合征施行Bentall手术,5例夹层动脉瘤行升主动脉置换。结果术后早期死亡1例,死亡率8.3%,死亡原因术后吻合口出血。术后并发症:呼吸衰竭1例,纵隔感染合并胸骨哆开1例,上消化道穿孔1例,均经积极治疗后痊愈。随访8个月～6年(平均2.57年),心功能恢复至Ⅰ级9例,Ⅱ级2例。结论采用不同术式治疗胸主动脉瘤可取得良好效果。手术关键在于处理好主动脉夹层和吻合口的出血以及在冠状动脉重建过程中避免出现冠状动脉扭曲和吻合口漏血以及张力。     

Three-dimensional echocardiography of the thoracic aorta

OBLECTIVES: The feasibility and diagnostic potential of three-dimensionalechocardiography, using transoesophageal multiplane echocardiographyfor the assessment of thoracic aortic pathology, has not beenevaluated. METHODS: We studied 21 patients (10 women, 11 men), mean age 52·1years (range 20–78). Images for three dimensional reconstructionwere acquired during a diagnostic multiplane transoesophagealechocardiographic examination. In all, 30 acquisitions wereperformed: 19 of the ascending aorta and 11 of the arch anddescending aorta. Three-dimensional reconstruction was performedto visualize normal aortic segments in three patients with anormal thoracic aorta, postoperative anatomy in seven, chronicaortic dissection in two, non-dissecting aneurysm in seven (threepatients had coexisting thrombi) and protruding aortic atheromain two. RESULTS: Three-dimensional image quality was scored excellent in 17 acquisitions(57%), adequate in 10 (33%) and inadequate in three (l0%). Anyplanetwo-dimensional views of regions of interest of the aorta werereconstructed off-line from the data sets, which provided improvedanalysis with potential for quantitation. Advanced computerassisted imaging modalities (electronic vivisection, lumen castdisplay, detail extraction) were feasible. CONCLUSIONS: We conclude that three-dimensional echocardiography of the thoracicaorta is feasible. Adequate image quality is obtained in thevast majority of patients, which adds additional qualitativeand quantitative information to routine multiplane transoesophagealechocardiographic studies. (Eur Heart J 1996; 17: 1584–1592)     

Left main bronchus compression by massive thoracic aorta aneurysm as a cause of dyspnea

In the past, thoracic aorta aneurysms were common findings, especially in the older population. With the development of imaging methods and surgical treatment, the diagnosis can now be made earlier, revealing the condition at an earlier stage. However, even today we see patients, mainly the elderly, with huge thoracic aorta aneurysms. Because of ambiguous radiological findings, this condition can be initially misdiagnosed as mediastinal tumors. In this case report is presented a case of such thoracic aorta aneurysm, which caused dyspnea by left main bronchus compression. The purpose of this report is to highlight thoracic aortic aneurysms as a potential rare case dyspnea and cough.     

支架型人工血管治疗降主动脉假性动脉瘤

目的探讨支架型人工血管介入治疗降主动脉假性动脉瘤的可行性及疗效。方法2001年9月至2004年12月,行支架型人工血管治疗降主动脉假性动脉瘤8例,其中男性7例,女性1例,年龄22~65岁,平均(45.4±15.1)岁。病因4例为外伤,1例为动脉硬化,3例病因不明。瘤体直径(3.9±1.3)cm。4例为急诊手术,4例择期手术。结果6例采用全身麻醉,2例采用硬膜外麻醉。支架型人工血管均顺利植入。术后30d内无死亡。1例有近端内漏。术后脑梗塞1例。术后随诊2~30个月,平均(9.3±10.7)个月,术后4个月死亡1例,病因为内漏导至动脉瘤破裂。1例于5个月后因再发假性动脉瘤,接受再次支架型血管植入术,于2次手术后2个月死亡。随诊死亡2例,死亡率25%。结论支架型人工血管是治疗主动脉假性动脉瘤的有效方法,中远期效果还有待进一步观察。     

Endovascular treatment of the malignant thrombus in the descending thoracic aorta

Thrombus in the Non-aneurysmal, Non-atherosclerotic Descending Thoracic Aorta (NAADTA) represents a rare source of peripheral arterial embolism. Despite being mostly asymptomatic process, its consequences can be very serious. In this case report, we described the case of a patient with malignant thrombus occurring in otherwise “healthy” descending thoracic aorta, already complicated by embolization into superior mesenteric artery, subsequently solved by stent graft implantation into the thoracic aorta.     

低温停循环选择性脑灌注应用于胸主动脉瘤的手术治疗

目的 :总结右锁骨下动脉插管、中度低温停循环 (HCA)、顺行选择性脑灌注 (ASCP)行胸主动脉瘤手术治疗的经验。方法 :11例患者中 ,男 10例 ,女 1例 ,夹层动脉瘤 10例 (慢性DeBakeyI型 5例 ,Ⅱ型 4例 ,急性Ⅱ加Ⅲ型 1例 ) ,升主动脉瘤加降主动脉缩窄 1例 ,均并发主动脉瓣中重度反流。术中采用右锁骨下动脉 右房插管 ,建立体外循环后并行降温至 30℃ ,阻断升主动脉 ,处理近端并继续降温至 2 3℃ ,阻断无名动脉 ,转为HCA加ASCP处理远端。 10例行Bentall术 ,1例行Bentall加升主动脉 降主动脉搭桥术。平均体外循环时间 (112 .3±37.9)min ,HCA加ASCP时间 (2 5 .4± 8.8)min。结果 :所有患者均于术后 4～ 6h清醒 ,无死亡及脑部并发症。结论 :以右锁骨下动脉插管建立体外循环、HCA加ASCP ,操作简便易行 ,可安全地延长停循环时限及有效防止脑部并发症 ,提高胸主动脉瘤的手术疗效     

单中心主动脉腔内隔绝术治疗胸降主动脉扩张性疾病的疗效评价

目的 评价主动脉腔内隔绝术治疗胸降主动脉扩张性疾病的近期和远期疗效及安全性.方法 选择沈阳军区总医院2002年4月至2013年10月行主动脉腔内隔绝术治疗胸降主动脉扩张性疾病的患者449例,其中男349例,女100例,年龄（54.3±11.9）岁.经股动脉切开植入覆膜支架封堵胸降主动脉夹层破口或隔绝胸主动脉瘤,主动脉造影确认疗效;合并严重冠状动脉狭窄的患者,于腔内隔绝术后3-7 d完成经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗.观察主动脉疾病患者PCI治疗的疗效.结果 主动脉腔内隔绝术操作成功率为100％,共植入416枚主体覆膜支架及56枚短体覆膜支架.43例患者完全封闭左锁骨下动脉开口,仅1例患者出现严重窃血综合征,行血管旁路移植术.34例患者行PCI治疗成功率为100％,对37支靶血管共植入45枚冠状动脉支架,无出血、心肌梗死等并发症.68例患者出现腔内隔绝术后综合征,76例患者术后有残余漏,其中11例因内漏明显同台或再次行手术治疗.住院期间主动脉破裂病死率为1.3％（6/449）.术后随访（68±29）个月,随访率为79.0％（350/443）.随访期间共死亡患者23例（6.6％）：明确主动脉血管破裂死亡4例,急性心肌梗死1例,脑出血4例,肾功衰竭死亡3例,多器官功能衰竭2例,恶性肿瘤4例,猝死5例（原因不明）.25例联合PCI治疗患者临床造影随访主要心血管事件发生率为8.0％（2/25）.结论 主动脉腔内隔绝术治疗胸降主动脉扩张性疾病近期及长期疗效好,并发症发生率低.合并冠状动脉粥样硬化性心脏病患者择期二次行PCI治疗安全可行,主要心血管事件发生率低.     

血清EREG和MGP水平与胸主动脉瘤的关系

目的:探讨去分化平滑肌分泌的表皮调节素(EREG)和基质Gla蛋白(MGP)与胸主动脉瘤(TAA)的关系。方法:采集36例TAA患者血清和36例正常对照血清,应用酶联免疫吸附法(ELISA)测定血清EREG和MGP水平,并分析其与胸主动脉病变长度及程度的关系。结果:TAA组血清EREG水平高于对照组,为(70.79±18.00)pg/ml对(33.06±1.34)pg/ml,P=0.045;血清MGP水平低于对照组,为(122.52±6.78)ng/ml对(153.74±8.57)ng/ml,P=0.006;EREG水平与主动脉病变长度和病变程度呈正相关。结论:TAA患者血清EREG水平升高,且升高程度与病变长度和病变程度正相关,而MGP水平降低,有一定的诊断价值。     

The Value of transoesophageal echocardiography for diagnosis of thoracic aorta pathology

The potential of transoesophageal echocardiography for preoperativediagnosis of thoracic aorta pathology was evaluation in 15 patientswith aortic aneurysm. The transoesophageal echocardiographicfindings were compared with 14 computed tomograms and 21 angiograms.Six patients underwent only transoesophageal echocardiography.All patients were operated upon and the surgical findings wereused as a reference for these diagnostic methods. Transoesophagealechocardiography establised a complete and correct diagnosisin 27 patients. The diagnosis was partically correct in threepatients, all having an aortic dissection. A complete and correctdiagnosis was obtained by computed tomography and angiographyin 8 and 17 patients, respectively. The results indicated thattransoesophageal echocardiography is a sensitive and convenientmethod for the definitive diagnosis of pathology of the thoracicaorta. It could become the technique of choice in patients suspectedof having acute aorta pathology as it enables a rapid and definitivediagnosis at the bedside.     

Short term outcome of thoracic endovascular aortic repair in patients with thoracic aortic diseases

Aim and background

Open surgical repair for thoracic aortic diseases is associated with a high perioperative mortality and morbidity. Most of type B aortic dissections are uncomplicated and are medically treated which carries a high mortality rate. Thoracic endovascular aortic repair is the first-line therapy for isolated aneurysms of the descending aorta and complicated type B aortic dissection. The aim of this study is to test the safety of early thoracic endovascular aortic repair in patients with uncomplicated type B aortic dissection and patients with thoracic aortic aneurysms.