经皮内膜瓣开窗术治疗主动脉夹层引起的缺血并发症

目的 探讨单纯经皮内膜瓣开窗术治疗主动脉夹层引起的主动脉分支缺血并发症的意义与可能性。方法 1例DeBakevⅢb型主动脉夹层男性患者,因夹层瘤严重撕裂主动脉内膜致双下肢麻痹。经皮穿刺股动脉行单纯夹层瘤内膜开窗术。结果双下肢血流恢复,症状消失,双侧股、足背动脉正常触及。结论 经皮内膜瓣开窗术治疗主动脉夹层引起缺血并发症是安全、有效的措施,但需尽早。     

胸、腹主动脉病变的血管内治疗

目的探讨胸、腹主动脉病变不同血管内治疗方法的临床疗效。方法7例患者,其中DebakeyⅢ型主动脉夹层5例(4例行一体式支架腔内隔绝术,1例行内膜瓣开窗术);DebakeyⅢ型主动脉夹层外院外科人造血管置换术后降主动脉假性动脉瘤形成1例(行一体式支架腔内隔绝术);肾动脉开口以下腹主动脉瘤1例(行分体式支架腔内隔绝术)。结果5例一体式支架腔内隔绝术均获成功,2例出现Ⅰ型内漏,1例经球囊扩张后内漏消失,1例30 min后内漏减少,未处理;1例内膜瓣开窗术后患者双下肢缺血症状消失;1例分体式支架腔内隔绝术后造影提示动脉瘤消失,无内漏发生。结论应用血管内支架移植物或内膜瓣开窗术治疗胸、腹主动脉病变安全有效,其中分体式支架的临床应用具有更好的前景。     

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。     

StanfordB型主动脉夹层腔内治疗临床分析

目的分析StanfordB型主动脉夹层腔内修复的治疗经验。方法总结2012年7月～2013年2月经腔内治疗7例StanfordB型主动脉夹层患者资料,所有患者均在计算机体层血管造影（Computedtomographyangiography,CTA）条件下确定诊断,在数字减影血管造影（Digitalsubtractionangiography,DSA）和全身麻醉条件下行腔内隔绝术。按照术后1个月、6个月、12个月的随访计划,观察瘤体形态学改变、治疗效果及并发症的发生情况。结果腔内技术成功率100％（7,7）,临床成功率100％（7,7）,术后住院期间无死亡患者,无左锁骨下动脉完全封闭,部分封闭2例,左锁骨下动脉烟囱支架2例,夹层累及腹腔干1例,肠系膜上动脉1例,累及一侧肾动脉2例,腹主动脉段存在远端破口2例,髂总动脉及髂外动脉存在远端破口1例。所有患者术后均未出现脑供血不足的临床表现,无截瘫情况发生,经过1个月、6个月及12个月的随访均正常存活,无新破口出现。结论StanfordB型主动脉夹层腔内治疗是一种有效方法,在血压控制平稳条件下,应尽快完成腔内修复治疗,对于夹层累及多个脏器动脉情况,应观察脏器血液灌注流速及流量,如有脏器严重缺血情况出现,应及时放置支架缓解血供,对于多个远端破口病例,应根据具体情况,在避免并发症的基础上尽早完成破口的封闭,并加强随访,观察病变处的动态变化。     

体外支架双开窗技术在Stanford B型主动脉夹层伴迷走锁骨下动脉患者腔内治疗中的应用

【摘要】 目的 总结采用主动脉支架预开窗联合分支支架技术治疗伴有迷走锁骨下动脉（ASA）的Stanford B型主动脉夹层（TBAD）患者的经验。 方法 2017年至2019年宁夏医科大学总医院在TBAD患者术前主动脉CTA检查中发现4例伴发ASA。4例患者均为男性,中位年龄47.3岁（44～52岁）,均接受择期胸主动脉腔内支架预开窗联合分支支架修复术治疗,随访观察腔内修复术可行性和临床疗效。 结果 4例患者择期手术均获成功,未发生围手术期死亡、严重脑卒中或脊髓缺血并发症。随访12～36个月,无患者死亡,无上肢缺血、后循环缺血、脊髓缺血等情况出现。所有患者的锁骨下动脉（SA）和ASA通畅,无分支支架狭窄/闭塞。结论 采用体外支架双开窗技术腔内修复治疗TBAD伴ASA可行,近中期效果满意,远期效果仍需随访;建议同时重建双侧SA,以保留上肢动脉血供,更重要的是保留脊髓和椎基底动脉血供。     

经皮内膜瓣开窗术及内支架置入术治疗主动脉夹层（附一例报告及文献复习）

目的 探讨经皮主动脉夹层内膜瓣开窗术（FIF）及内支架（ES）置入术治疗主动脉夹层的临床应用价值。方法 男,54岁,DeBakey III b型主动脉夹层,内膜瓣破裂口位于降主动脉,腹主动脉及右髂动脉真腔变窄,最窄处内径仅为3mm,经股动脉行主动脉夹层FIF及ES置入术,共置入ES4枚。结果 腹主动脉真腔及其各分支血流基本得到恢复,初步观察最狭窄处内径增至12．3mm,病人症状完全消失,结论 经皮主动脉夹层FIF及ES置入术治疗主动脉夹层具有损伤性小,并发症少,疗效显著等特点,因此,可作为治疗某些主动脉夹层珠安全有效的首选方法。     

StanfordB型胸主动脉夹层动脉瘤合并肾缺血的诊治（附3例报告）

为探讨合并肾缺血的StanfordB型胸主动脉夹层动脉瘤的诊断和处理,分析1996年1月至2000年4月收治的StanfordB胸主动脉夹层动脉瘤29例,其中合并肾缺血3例,为急性期2例,慢性期1例。急性期1例发病后第3天死亡,中1例同时合并肾缺血或双下肢缺血,经夹层隔膜开窗术缓解;慢性期1例腔内隔绝术治愈夹层后肾缺血自行缓解。提示合并肾缺血的StanfordB胸主动脉夹层动脉姑息性转流手术有助于缓解症状,提高生存率;对于慢性StanfordB胸主动脉夹层动脉瘤合并肾缺血的患者,腔内隔绝术在治愈夹层动态瘤的同时恢复了真腔供血,肾缺血可同时治愈。     

Stanford B型胸主动脉夹层动脉瘤合并肾缺血的诊治(附3例报告)

为探讨合并肾缺血的StanfordB型胸主动脉夹层动脉瘤的诊断和处理 ,分析 1996年 1月至 2 0 0 0年 4月收治的StanfordB型胸主动脉夹层动脉瘤 2 9例 ,其中合并肾缺血 3例 ,为急性期 2例 ,慢性期 1例。急性期 1例发病后第 3天死亡 ,另 1例同时合并肾缺血和双下肢缺血 ,经夹层隔膜开窗术缓解 ;慢性期 1例经腔内隔绝术治愈夹层后肾缺血自行缓解。提示合并肾缺血的StanfordB型胸主动脉夹层动脉姑息性转流手术有助于缓解症状 ,提高生存率 ;对于慢性StanfordB型胸主动脉夹层动脉瘤合并肾缺血的患者 ,腔内隔绝术在治愈夹层动脉瘤的同时恢复了真腔供血 ,肾缺血可同时治愈     

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。     

胸主动脉腔内修复术联合体外开窗技术治疗累及主动脉弓的复杂胸主动脉疾病

【摘要】 目的 报道胸主动脉腔内修复术（TEVAR）联合体外开窗技术治疗累及主动脉弓的复杂主动脉疾病的初步经验,并探讨其可行性、安全性和有效性。 方法 回顾性分析2017年2月至2019年11月大连医科大学附属第一医院在TEVAR术中采用体外开窗技术治疗的15例累及主动脉弓的复杂胸主动脉疾病患者临床资料。分析技术成功率、围术期死亡率和术后随访等。 结果 15例患者中,主体开窗支架近端植于主动脉Z0、Z1、Z2区各5例。移植物单开窗9例,双开窗4例,三开窗2例。总计重建26条分支血管,其中无名动脉3条、左颈总动脉8条、左锁骨下动脉11条、迷走右锁骨下动脉2条以及无名动脉、左颈总动脉共干各1条;人工遮盖左锁骨下动脉4条。术后所有重建分支血管即刻造影显示血流通畅,技术成功率100%。围术期死亡2例（13.3%）,无缺血性脑卒中、截瘫等严重并发症发生。随访期失访2例（3条分支血管）。1例1条左锁骨下动脉狭窄,2例（13.3%）见少许内漏,均逐渐减少,2例死亡。 结论 TEVAR体外开窗技术治疗累及主动脉弓的复杂主动脉疾病可行、安全有效,近期效果满意。     

Percutaneous fenestration of aortic dissection: Salvage of an ischemic solitary left kidney

The false channel of a type III aortic dissection caused acute renal ischemia by compression of the origin of the left renal artery in a patient with status post-right nephrectomy. To relieve the ischemia and restore renal function, percutaneous balloon fenestration was performed successfully.     

Type B aortic dissection complicating renal artery angioplasty and stent placement

Percutaneous renal artery stent placement has been demonstrated to improve blood pressure control and stabilize renal function in patients with atherosclerotic renal artery disease. However, this procedure is not without risk of significant morbidity, and its effectiveness, as compared to alternative treatments, has not been adequately established. The authors report a case of acute type B aortic dissection complicating renal artery stent placement. The authors postulate that an intimal disruption occurred during initial balloon angioplasty, and that repeated application of radial, shear, and torque forces during stent placement may have extended the injury. The diagnosis of acute aortic dissection should be considered in patients with suggestive symptoms immediately after stent placement.     

Renal Artery Stent Placement Complicated by Development of a Type B Aortic Dissection

Percutaneous renal artery angioplasty and stent placement have demonstrated safety and effectiveness in the treatment of selected patients with renovascular hypertension and ischemic nephropathy. Major complications have been predominantly confined to the affected renal artery and kidneys, including renal artery dissection and/or thrombosis, distal embolization, and contrast-related nephropathy. We report a case in which treatment of an ostial renal artery lesion with placement of a balloon-expandable stent was complicated by the development of an acute Type B aortic dissection.     

Percutaneous recanalization of a renal artery in aortic dissection.

Chronic renal failure acutely worsened in a patient with a type B aortic dissection. Aortography revealed an occlusion of the left renal artery without renal intimal tear. Percutaneous recanalization, performed with a self-expandable stent, resulted in improvement in the renal function. This technique offers a new therapeutic choice in patients with visceral complications of aortic dissection.     

Percutaneous balloon fenestration and stent placement for lower limb ischemia complicated with type B aortic dissection

We report a case of lower limb ischemia secondary to type B aortic dissection, which was successfully treated with endovascular aortic fenestration and stent placement. In this case, we were not able to restore adequate flow to the ischemic limb by means of aortic balloon fenestration alone, so additional stent placement was required to buttress the true lumen and fenestra. There was no recurrence of lower limb ischemia complications during the follow-up period. Aortic balloon fenestration with stent placement seems to be a safe and effective technique to salvage an ischemic lower limb complicated by acute aortic dissection.     

胸主动脉覆膜支架并左锁骨下动脉烟囱术疗效分析

目的探讨胸主动脉覆膜支架植入术在支架近端锚定区不足时左锁骨下动脉的处理方法及支架直接覆盖左锁骨下动脉开口并左锁骨下动脉"烟囱"术的可行性。方法回顾分析2009年12月-2011年4月收治的支架近端锚定区不足的15例胸主动脉病变患者(B型夹层6例,假性动脉瘤1例,动脉瘤4例,穿透性溃疡4例),其中13例病变距左锁骨下动脉锚定区小于15 mm,2例大于15 mm。采用胸主动脉覆膜支架并左锁骨下动脉烟囱术治疗,观察脑及上肢缺血并发症发生情况。术后评价内漏、左锁骨下动脉显影等结果。结果 15例患者均成功地在主动脉内植入覆膜支架1枚,并在左锁骨下动脉植入"烟囱"支架1枚,术后患者均未出现神经系统并发症及左上肢严重缺血症状。术后5 d～3个月复查,主动脉覆膜支架形态良好,未发现I型内漏,"烟囱"支架内血流通畅。结论胸主动脉覆膜支架植入术中近端锚定区不足时,直接覆盖左锁骨下动脉开口并左锁骨下动脉"烟囱术"以延长锚定区并保持左锁骨下动脉通畅,更为安全。     

Percutaneous fenestration of a type I aortic dissection for relief of lower extremity ischemia

A 36-year-old patient underwent successful percutaneous fenestration of a type I aortic dissection which had caused occlusion of the right common iliac artery and ischemia of the right lower extremity. The patient is currently (6 months postfenestration) ambulating without any signs of vascular compromise. The technique may be useful in patients who are at high risk for surgical procedures.     

Endovascular management of chronic type B dissecting aortic aneurysm utilizing aortic and renal stents

Over the last 10 years endovascular stent-graft placement has been increasingly used to treat complicated acute Type B thoracic aortic dissections. While studies have demonstrated the use of additional aortic stent-grafts to treat continued false lumen perfusion and case reports have detailed the use of renal artery stents to treat renal ischemia related to aortic dissection, to our knowledge the adjuvant use of renal artery stents to reduce false lumen perfusion has not been reported. We present the case of a 72-year-old male who had previously undergone endovascular repair of a complicated Type B thoracic aortic dissection and presented with an expanding false lumen in the peridiaphragmatic aorta despite coverage of the entire thoracic aorta. This was treated by closure of a right renal fenestration using a renal stent.     

Isolated Spontaneous Dissection of the Superior Mesenteric Artery: Percutaneous Stent Placement in Two Patients

Isolated spontaneous dissection of the superior mesenteric artery (SMA) is a rare cause of acute mesenteric ischemia. Two patients were successfully treated by percutaneous stent placement within the main trunk of the SMA. Emphasis is placed on the feasibility of nonsurgical management with percutaneous stent placement of isolated spontaneous dissection of the SMA.     

Initial experience with percutaneous transluminal angioplasty in the management of Takayasu's arteritis

We have performed percutaneous transluminal angioplasty (PTA) for 15 arterial stenoses in 11 patients with Takayasu's arteritis. The lesions included tight, proximally located renal artery stenosis (12 stenoses; nine patients), localized abdominal aortic stenosis (two patients) and occluded left common iliac artery (one patient). Clinically successful dilatation was achieved in seven patients (10 stenoses) with renal artery stenosis, in both the patients with abdominal aortic stenosis and in the only patient with an occluded left common iliac artery. No complications related to the procedure were encountered. The follow-up period (n = 7) ranged between 1 and 16 months, mean follow-up period after renal angioplasty was 5 months and after abdominal aortic angioplasty was 12.5 months. Initial success has been maintained in both the patients with abdominal aortic stenoses and in four out of five patients with renal artery stenosis. Percutaneous transluminal angioplasty offers an attractive alternative for the management of stenosing lesions in Takayasu's arteritis with good short term results.