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。

Endovascular graft exclusion for aortic discession and aneurysm

Objective To evaluate the safety and clinical efficacy of a stent-graft in the treatment of type B aortic discession.Methods From January 2000 to Decmber 2006,48 patients with Stanford B aortic discession were treated with endovacular stent-graft under fluorescent guidance.Prior to the procedure,aortic angiography was performed in all patients via the left brachial artery to determine the true and false lumen of the aorta,the orifice of the aortic discession and the other branches of the aortic artery.After surgical exposure of the right femoral artery,the stent-graft delivery system was passed over the stiff guidewire and advanced until the middle of the stent-graft cover the orifice.The stent-graft was then deployed by pulling back the introducer sheath.Then an aortic angiography was performed immediately after the procedure to evaluate the correct placement of the stent-graft and the changes of blood flow supply the true lumen of the aorta,the viscus and the lower limbs.Results Stent-graft placement was technically successful in all patients,and the orifice of the aortic discussion was occluded in 46 patients with a successful rate of 95.8%.The blood pressure of false lumen was dropped immediately after the procedures with improvement of the blood flow in the lower limbs and the viscus greatly.Conclusions Transluminal endovascular stent-graft placement was a safe and effective procedure for the treatment of type B discession and worthy of spreading extensively.