Standford B型主动脉夹层累及内脏动脉的腔内重建

目的:探讨Standford B型主动脉夹层累及内脏动脉的腔内重建方法、适应证和疗效。方法:2006年7月至2010年6月共85例Standford B型主动脉夹层患者接受腔内隔绝术,13例累及内脏动脉并引起脏器缺血,其中8例累及肠系膜上动脉,5例累及肾动脉。7例胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)后缺血改善,4例行1期支架重建内脏动脉,2例未予处理。结果:4例支架重建内脏动脉均获成功,无围手术期死亡。随访1～18个月,平均7.5个月,随访率100%;4例重建病例无内脏缺血;2例未处理病例,1例存在慢性肾功能不全,另1例于术后2个月因全身衰竭死亡。结论:正确判断主动脉夹层累及内脏动脉的供血方式、TEVAR术后血供改变情况以及选择适当的处理方式,是保证内脏血供的重要因素。腔内重建内脏动脉创伤小,疗效确切。

Endovascular revascularization for visceral ischemia in patients of type B dissection

Objective：To investigate the method,indication and effect of endovascular revascularization for invovled visceral ischemia in patients of type B dissection.Methods：85 cases of type B dissection received endovascular grafting exclusion from July,2006 to June,2010.13 of which suffered from visceral ischemia;superior mesenteric arteries were invovled in 8 cases and renal arteries were involved in the other 5.Post thoracic endovascular aortic repair（TEVAR）,visceral ischemia was improved in 7 cases.In the other 6 cases,4 received endovascular revascularization and 2 were not treated.Results：The process of endovascular revascularization has successed without perioperitive mortality.The follow-up were 1 ～ 18 months with average of 7.5 and follow-up rate of 100%.There were no visceral ischemia in the 4 grafting cases;however,the one ontreated suffered from chronic renal failure and the other one died 2 months post operation for systemic failure.Conclusion：Accurate determination on supply method of involved visceral artery in type B dissection and supply alteration post TEVAR,and choose appropriate treatment are the vital factors to assure visceral supply.Endovascular revascularization is effective and safe method.