症状性主动脉穿透性溃疡的腔内修复术

目的 探讨症状性主动脉穿透性溃疡（penetrating atherosclerotic ulcer，PAU）的临床诊断和支架型人工血管腔内修复术的临床价值。方法 回顾分析2004年9月至2010年4月治疗的12例症状性PAU患者的临床资料，所有患者均有突发胸背部疼痛等急性主动脉综合征的临床表现，计算机断层扫描血管成像（computer tomography angiography，CTA）确诊为Stanford B型PAU，其中8例合并主动脉壁间血肿，所有患者均在全麻下接受支架型人工血管腔内修复术，两例附加杂交旁路手术延长近远侧锚定区。本组12例中10例患者获得随访，随访率83.3％。随访时间1～4年（中位时间36个月），随访率83.3％ (10/12)。结果 12例患者共植入支架型人工血管12枚，其中植入支架直径32～40 mm，平均(35.7 ±2.5) mm，长度152 ～ 202 mm，平均(163±19) mm。1例溃疡较大病例支架人工血管植入后存在极少量内漏外，其他溃疡均隔绝满意。技术成功率100％。围手术期无不良事件发生。随访中患者无症状复发及死亡。CTA检查结果满意无内漏，1例少量内漏患者术后3个月复查内漏消失。结论 支架型人工血管腔内修复术因其微创、有效可能成为现阶段症状性PAU的首选治疗手段，术后严格的血压控制是长期疗效的有效保证。

Endovascular repair of symptomatic penetrating atherosclerotic ulcer of the thoracic aorta

Objective To evaluate endovascular repair(EVAR) of penetrating atherosclerotic ulcer (PAU) of the thoracic aorta. Methods There were 12 cases of PAU treated at our department. All the cases had severe acute thoracic pain. Computer tomography angiography (CTA) showed well outlined ulcer in 12 cases, intramural hematoma in 8 cases. EVARs were done under general anaesthesia and 12 stent grafts were used. Two cases received by-pass procedure ahead of EVARs because of main branches involved.Patients were followed up with CTA from 12 months to 4 years( median 36 months). Results A total of 12 stent grafts were implanted to 12 patients. The average diameter of stent graft was ( 35.7 ± 2. 5 ) mm(32-40 mm) , length was ( 163 ± 19) mm ( 152-202 mm). There was a very small internal leakage in one case with large size ulcer after implantation of stent graft, other ulcers were excluded completely. Primary technical success rate was 100％. There were no perioperative death and severe complications. All cases were free from symptoms after operation and alive during follow-up. CTA showed satisfactory results without internal leakage. The small leakage in the case disappeared within 3 months.Conclusions Being miniinvasive and effective, EVAR is the choice of therapy for symptomatic PAU.