腔内隔绝术治疗Stanford B型夹层动脉瘤

目的 探讨腔内隔绝术EVGE治疗Stanford B型夹层动脉瘤的价值及应用经验。方法采用国产人工覆膜支架治疗Stanford B型夹层动脉瘤9例。经核磁共振（MRI）、主动脉造影明确瘤体和夹层破口位置及大小,标记破口位置。准确选定覆膜支架型移植物,DSA监控下将支架导入瘤腔及裂口位置,完全封闭破口,使真、假腔隔绝。结果破口全部封闭成功,支架没有移位、狭窄等并发症。术后超声和螺旋CT检查假腔内有血栓形成。9例患者均康复出院。结论EVGE是一种治疗Stanford B型夹层动脉瘤的有效方法,早期结果满意,中远期效果还有待进一步观察。     

腔内隔绝术在主动脉瘤外科治疗中的应用

目的：探讨腔内隔绝术治疗主动脉夹层动脉瘤、腹主动脉瘤的操作方法及近期疗效。方法：采用腔内隔绝术治疗主动脉夹层动脉瘤3例、腹主动脉瘤2例。结果：5例主动脉瘤腔内隔绝术均获得成功，术后3例主动脉夹层动脉瘤的假腔立刻消失，2例腹主动脉瘤瘤体成功隔绝。无支架移位；术中发生内漏1例，经及时处理后消失；2例术后出现移植后综合征，经对症处理后缓解。随访3-21个月，无移植物移位及器官缺血，假腔内见血栓形成。结论：腔内隔绝术治疗主动脉瘤创伤小．安全、恢复快，有着较好的近期效果。     

双源CT血管成像在主动脉夹层腔内隔绝术后随访的应用

目的探讨双源CT血管成像对主动脉夹层腔内隔绝术后并发症的诊断价值。方法回顾性分析40例主动脉夹层腔内隔绝术后双源CT血管成像资料,其中男性33例,女性7例,年龄32~72岁,平均年龄49.05岁。所有患者的图像分析及后处理工作均在Syngo MMWP后处理工作站上完成,重建方法为容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)多种后处理技术。22例患者的术中数字减影血管造影(DSA)资料和术后双源CT血管成像资料进行对照分析。重点观察和分析了支架的位置、支架有无内漏、重要分支血管的通畅程度及真假腔情况。结果 40例均可清楚显示支架位置、形态、个数、对假腔的封闭情况。真、假腔内径在手术前、后差异均具有统计学意义(P0.05)。40例患者中术后发生支架内漏8例,发生逆行性夹层1例,支架内血栓形成1例。57支腹部分支及髂总动脉受累,其中腔内隔绝术后23支受累血管真腔管径不同程度扩大,假腔管径变小,34支变化不明显,3支无名动脉受累,腔内隔绝术后修复。双源CT血管成像与DSA资料对照分析,1例内漏DSA未能显示。结论双源CT血管成像是一种方便、快捷、无创的检查手段。综合原始及后处理资料,双源CT血管成像可以明确主动脉夹层腔内隔绝术后并发症的诊断,应作为主动脉夹层腔内隔绝术后诊断并发症的重要影像学检查方法。     

腔内隔绝术治疗主动脉夹层动脉瘤

目的评价血管内支架置入治疗夹层动脉瘤的安全性和临床疗效。方法2000年1月至2006年12月,48例StanfordB型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夹层动脉瘤安全可行、效果明显,值得临床进一步推广。     

杂交手术治疗累及弓部的主动脉夹层的临床研究

目的 探讨杂交手术治疗累及主动脉弓部的主动脉夹层的方法及疗效.方法 自2009年1月至2012年1月,成都军区总医院共对16例累及主动脉弓部的主动脉夹层患者完成了杂交手术治疗.其中男性11例,女性5例,年龄50～72岁[(56.3±7.1)岁].Stanford A型主动脉夹层(夹层起源于升主动脉)5例,B型夹层(夹层起源于降主动脉)11例,病变均累及主动脉弓,不适宜单独行腔内隔绝治疗.11例采用胸骨正中切口或加颈部切口行升主动脉至头臂动脉旁路移植,5例单纯颈部切口行头臂动脉间旁路移植,然后行股动脉切口逆行主动脉腔内覆膜支架植入.术后即刻行升主动脉造影,术后3个月、1年及2年随访CT资料,观察支架和人工血管通畅情况.结果 所有患者均成功完成血管旁路手术,并植入覆膜支架.术中血管造影证实支架植入定位准确,无明显内漏和移位.主动脉夹层真腔血流恢复正常,旁路血管血流通畅,围手术期无死亡和严重并发症发生.随访16例,随访时间3.0 ～ 48.0个月[(24.O±8.2)个月],所有患者均生存,并恢复正常生活.术后3个月和术后1年、2年复查主动脉增强CT示:支架无移位和内漏,支架内及人工血管旁路血流通畅,未见脑部和肢体的缺血征象.结论 累及弓部的主动脉夹层可根据受累的部位及程度采用不同的杂交手术方法,杂交手术治疗累及主动脉弓部的主动脉夹层安全、有效,能明显减轻患者的创伤和痛苦,该治疗方法扩大了介入覆膜支架腔内治疗的适应证,但远期疗效有待迸一步观察.     

夹层动脉瘤腔内隔绝术围手术期护理

目的探讨夹层动脉瘤腔内隔绝术围手术期护理体会。方法对18例夹层动脉瘤拟行腔内隔绝术患者进行围手术期护理,术前作好入院指导及心理护理,调整患者心理状态以适应手术,防止夹层动脉瘤破裂;术后注意作好呼吸、循环系统的护理及尿量的观察,提高成功率,并进行总结。结果18例主动脉带膜支架全部成功植入,术后除3例发热外无其它并发症发生,均在2周内康复出院。结论尽管夹层动脉瘤腔内隔绝治疗系微创手术,但其本身有一定的并发症,加强围手术期护理,预防并及时处理并发症是提高手术成功率、保障患者痊愈的重要环节。     

主动脉腔内支架修复术治疗急性创伤性主动脉夹层

目的探讨主动脉腔内支架修复术治疗急性创伤性主动脉夹层(TAD)的治疗策略及疗效。方法回顾性分析2016年7月至2017年12月我院收治的8例急性创伤性主动脉夹层患者的临床资料。所有患者均行胸腹主动脉计算机体层摄影血管造影(CTA)明确诊断为Stanford B型,采用主动脉腔内支架修复术(EVAR)治疗。收集并分析各患者术前临床特点、术中手术资料、术后随访结果。结果手术时间(61. 2±25. 6) min,住院时间(12. 7±6. 3) d;围手术期无死亡病例,术后无左侧锁骨下动脉盗血、截瘫、肝肾功能衰竭及脑梗死等并发症。出院后随访3～23个月,平均(13. 2±9. 8)个月,复查CTA均显示破口封闭良好,支架无内漏、移位。结论与传统体外循环下人工血管置换相比,EVAR手术具有微创、便捷、安全有效等特点,是治疗急性创伤性主动脉夹层安全有效的方法。     

覆膜支架在腘动脉瘤腔内治疗中的应用

目的 分析使用覆膜支架对腘动脉瘤患者行腔内治疗的效果。方法 纳入联勤保障部队第九二〇医院行腔内修复的12例腘动脉瘤患者。观察动脉瘤变化,置入支架通畅情况,支架有无移位、断裂、内漏,肢体有无缺血及其他并发症。结果12例患者腔内修复术均获得成功。3例出现围术期并发症,其中切口血肿1例,蓝趾综合征1例,消化道出血1例。患者术后无夹层、血栓及假性动脉瘤形成,Viabahn支架无内漏、移位及断裂。随访期间1例出现股浅-腘动脉段动脉瘤形成,予以腔内覆膜支架修复;1例出现支架远心端局限性狭窄,狭窄约60%,予以球囊扩张后狭窄明显好转。随访1年,覆膜支架修复腘动脉瘤的通畅率为100%。1例患者术后16个月因心肌梗死死亡。结论 使用覆膜支架腔内修复腘动脉瘤的短中期疗效较好,安全有效。     

75例胸主动脉瘤的外科治疗临床分析

目的总结胸主动脉瘤的外科治疗方案以及经验体会。方法回顾性分析2003年9月—2013年10月蚌埠医学院第一附属医院心胸外科收治的75例各类胸主动脉病变患者的临床资料。其中9例Stanford A型主动脉夹层动脉瘤患者,行升主动脉+主动脉全弓置换手术3例、升主动脉+主动脉半弓置换手术6例;26例Stanford B型主动脉夹层动脉瘤患者,行体外循环下人工血管置换8例、腔内隔绝术18例;22例风湿性主动脉瓣病变合并升主动脉瘤样扩张患者(升主动脉直径>5 cm),行升主动脉置换+主动脉瓣置换术13例、升主动脉包裹+主动脉瓣置换术9例;17例马凡综合征患者行Bentall手术;1例升主动脉瘤合并先天性主动脉弓缩窄(导管后型)、主动脉瓣反流患者,在完成Bentall手术后行升主动脉至双侧股动脉搭桥手术。结果75例患者均手术顺利,手术时间65~280 min,平均(166.5依76.7)min;主动脉阻断时间28~138 min,平均(78.5依33.4)min;选择性脑灌注时间24~106 min,平均(53.1依18.7) min。1例行升主动脉+主动脉全弓置换手术患者因术后出血、多器官衰竭死亡。2例Bentall手术者因术后出血较多予二次手术止血。术后肺部感染3例、肾功能衰竭2例、短暂性室性心动过速1例、顽固性电解质紊乱1例,予积极对症治疗,均痊愈。行腔内隔绝术患者术后未见血管内漏及支架移位等并发症。65例获随访,随访6~110个月,平均(50.2依10.8)个月。随访期间,1例出现肠梗阻患者经保守治疗痊愈,1例因脑梗塞死亡,其余患者恢复满意,生活质量与治疗前相比,均得到显著提高。结论胸主动脉瘤种类较多,在进行胸主动脉瘤的治疗时,根据患者的具体情况、选择个体化治疗方案是取得良好治疗效果的关键。     

DebakeyⅢ型主动脉夹层腔内隔绝术后移植物及血管特征的双源CT血管成像研究

采用双源CT评价DebakeyⅢ型主动脉夹层腔内隔绝术后移植物及血管变化的特点。对39例DebakeyⅢ型主动脉夹层腔内隔绝术后患者的双源CT血管成像图像进行分析。发现39例患者术后均无支架断裂及移位,术后内漏15例(Ⅰ型12例、Ⅱ型2例、不明原因1例),17例假腔大量血栓形成,1例支架段假腔完全吸收。术前15例肾灌注异常病例,术后肾灌注改善9例,并且越靠近原发破口封堵部位,其血管重塑情况越明显。因此,双源CT血管成像可准确评价DebakeyⅢ型主动脉夹层腔内隔绝术后移植物情况及血管的解剖病理特点。     

Endovascular stent-graft placement for the treatment of acute aortic dissection.

BACKGROUND: The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. METHODS: We studied the placement of endovascular stent-grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal stent-graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multiple branch vessels was observed in 7 patients (37 percent). The stent-grafts were made of self-expanding stainless-steel covered with woven polyester or polytetrafluoroethylene material. RESULTS: Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 19 patients. Complete thrombosis of the thoracic aortic false lumen was achieved in 15 patients (79 percent), and partial thrombosis was achieved in 4 (21 percent). Revascularization of ischemic branch vessels, with subsequent relief of corresponding symptoms, occurred in 76 percent of the obstructed branches. Three of the 19 patients died within 30 days, for an early mortality rate of 16 percent (95 percent confidence interval, 0 to 32 percent). There were no deaths and no instances of aneurysm or aortic rupture during the subsequent average follow-up period of 13 months. CONCLUSIONS: These initial results suggest that stent-graft coverage of the primary entry tear may be a promising new treatment for selected patients with acute aortic dissection. This technique requires further evaluation, however, to assess its therapeutic potential fully.     

Features of Debakey III aortic dissection after endovascular graft exclusion: evaluation with DSCT angiography

The purpose of this study was to evaluate the prothesis and vascular features of Debakey III aortic dissection by DSCT angiography after endovascular graft exclusion. We performed a retrospective analysis of 39 Debakey III aortic dissection patients who underwent DSCT angiography after endovascular graft exclusion. After the operations in this study, all the 39 patients had no stent fracture and migration, 15 among all the 39 had endoleaks (type I 12 patients, type II 2 patients, 1 patient had no reason), 17 had large amount of thrombosis in false lumen, and 1 had false lumen outside the stent absorbed completely. While before the operations, 15 patients had abnormal renal perfusion pre-operation, and 9 of them had recovered after the operations. And the nearer located to the initial exclusive place, the more obviously the aortic remodeling occurred. In conclusion, DSCT angiography can accurately evaluate the prosthesis and anatomic-pathologic features of Debakey III aortic dissection after endovascular graft exclusion.     

Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.

BACKGROUND: The treatment of thoracic aortic dissection is guided by prognostic and anatomical information. Proximal dissection requires surgery, but the appropriate treatment of distal thoracic aortic dissection has not been determined, because surgery has failed to improve the prognosis. METHODS: We prospectively evaluated the safety and efficacy of elective transluminal endovascular stent-graft insertion in 12 consecutive patients with descending (type B) aortic dissection and compared the results with surgery in 12 matched controls. In all 24 patients, aortic dissection was diagnosed by magnetic resonance angiography. In each group, the dissection involved the aortic arch in 3 patients and the descending thoracic aorta in all 12 patients. With the patient under general anesthesia, either surgical resection was undertaken or a custom-designed endovascular stent-graft was placed by unilateral arteriotomy. RESULTS: Stent-graft placement resulted in no morbidity or mortality, whereas surgery for type B dissection was associated with four deaths (33 percent, P=0.09) and five serious adverse events (42 percent, P=0.04) within 12 months. Transluminal placement of the stent-graft prosthesis was successful in all patients, with no leakage; full expansion of the stents was ensured by balloon inflation at 2 to 3 atm. Sealing of the entry tear was monitored during the procedure by transesophageal ultrasonography and angiography, and thrombosis of the false lumen was confirmed in all 12 patients after a mean of three months by magnetic resonance imaging. There were no deaths or instances of paraplegia, stroke, embolization, side-branch occlusion, or infection in the stent-graft group; nine patients had postimplantation syndrome, with transient elevation of C-reactive protein levels and body temperature plus mild leukocytosis. All the patients who received stent-grafts recovered, as did seven patients who underwent surgery for type B dissection (58 percent) (P=0.04). CONCLUSIONS: These preliminary observations suggest that elective, nonsurgical insertion of an endovascular stent-graft is safe and efficacious in selected patients who have thoracic aortic dissection and for whom surgery is indicated. Endoluminal repair may be useful for interventional reconstruction of thoracic aortic dissection.     

新型国产覆膜支架腔内修复肾下型腹主动脉瘤的临床对照研究：近-中期随访结果与单中心经验总结

BACKGROUND: Limited by the high financial burden of stent-graft and proof of evident-based medicine, the popularization of endovascular abdominal aortic aneurysm repair, a mini-invasive method, is impeded in China. In order to reduce costs, development of domestic-made stents is imperative, but the relative research is still rare. OBJECTIVE: To compare the effect of domestic-made stent-graft (Percutek) and Gore Excluder in the endovascular abdominal aortic aneurysm repair. METHODS: From January to November 2014, there were 32 male patients with infrarenal abdominal aortic aneurysm, aged 56-79 years old with mean age of (70.2±6.9) years, admitted in the Vascular Surgery Department of the Affiliated Hospital of Qingdao University. Clinical data were collected and retrospectively analyzed. There were 11 cases undergoing domestic-made stent-graft repair and 21 undergoing Gore Excluder repair. Aortic CT angiography was performed at 1 and 6 months after surgery, and every 6 months thereafter to evaluate the effect of the two modalities. RESULTS AND CONCLUSION: Domestic-made stent-grafts were successfully implanted into the 11 patients, and there were 1 case of late type I endoleak, 1 of type II endoleak, 1 of iliac occlusion and 1 of death after surgery. Totally 11 stent-graft trunks, 18 iliac stent-grafts, 1 Cuff, and 1 bare metal stent were implanted in the domestic-made stent-graft group (2.8 stents/case). Totally 21 patients were subjected to Gore Excluder repair with the success rate of 90%, and 2 cases of intraoperative I type endoleak (10%), 2 of postoperative I type endoleak and 2 of postoperative II type endoleak were observed. Totally 21 stent-graft trunks, 28 iliac stent-grafts and 3 Cuff were implanted in the Gore Excluder group (2.47 stents/case). These results suggest that the novel domestic-made stent-graft has achieved a satisfactory outcome in endovascular abdominal aortic aneurysm repair, showing no significant differences in related indicators with the Gore Excluder; however, the long-term outcomes still need to be further studied.     

杂交手术治疗累及弓部的Stanford B型主动脉夹层的疗效分析

目的:探讨杂交手术在治疗累及弓部的Stanford B型主动脉夹层（TBAD）中的有效性和安全性。方法:前瞻性描述性研究。纳入2020年1月—2021年9月蚌埠医学院第一附属医院血管外科确诊为累及弓部的TBAD患者。其中男16例,女5例;年龄32~81（59.7±12.9）岁。患者均采用外科转流术和胸主动脉腔内修复术相...     

体外构建Stanford A型主动脉夹层3D三维动态模拟图及个体化组织工程血管北大核心

背景:Stanford A型主动脉夹层手术难度大、复杂程度高,需要在深低温停循环下行升主动脉全弓置换+降主动脉支架置入手术,对术者的操作要求很高。目的:探讨在体外构建Stanford A型主动脉夹层3D三维动态模拟图及个体化组织工程化血管制备的可行性,为未来为临床医师提供模拟手术过程。方法:选择2020年1月至2021年7月中国科学技术大学附属第一医院(安徽省立医院)收治的Stanford A型主动脉夹层患者17例,将患者CT影像数据导入到医学图像处理软件,重建出Stanford A型主动脉夹层的主动脉血管及其分支模拟图。对重建出的主动脉血管模型制作出夹层的3D三维动态模拟图,制定个体化组织工程化血管,同时测量主动脉夹层模型与CT血管造影在不同位置的血管内径。结果与结论:①精确制定出夹层的3D三维动态模拟图和模型,可以制备出个体化的组织工程化血管,满足临床人工血管材料需要;②在窦管交界水平主动脉、头臂干水平主动脉、左锁骨下动脉水平主动脉、头臂干、左颈总动脉、左锁骨下动脉部位,Stanford A型主动脉夹层3D三维动态模型的血管内径值与CT血管造影血管造影检测结果比较差异均无显著性意义(P>0.05);③结果提示,在体外可构建Stanford A型主动脉夹层3D三维动态模拟图及精确打印出Stanford A型主动脉夹层复杂的解剖结构,可以精确制备个体化组织工程化血管。     

Surgical stent-graft implantation by open procedure for type B aortic dissection without optimal landing zone

Thoracic endovascular aortic repair (TEVAR) has been considered as a first-choice treatment for type B aortic dissection (TBAD). However, some patients that is lack of optimal landing zones (<15 mm in dissected Z₂, Z₃ or the presence of a lusorian artery) still pose significant challenges for TEVAR. We utilized a surgical stent-graft implantation in the descending aorta combined with supra-aortic vessels transposition through median sternotomy for these special TBAD patients. The short- and mid-term results showed that our procedure is a good and alternative therapy for such kind patients.