支架型人工血管介入治疗主动脉夹层动脉瘤及主动脉穿透溃疡30例报告

目的探讨支架型人工血管介入治疗主动脉夹层动脉瘤和主动脉穿透溃疡的可行性及疗效。方法2001年6月至2004年3月,行支架型人工血管治疗主动脉夹层动脉瘤及主动脉穿透溃疡30例。男性24例,女性6例。平均年龄(523±119)岁。25例主动脉夹层动脉瘤中,慢性TypeB23例,急性TypeB1例,TypeA1例。主动脉穿透溃疡5例。术后随诊1～32个月。结果30例支架型人工血管均成功植入。5例有近端内漏,1例术中发生升主动脉夹层,2例分别在术后1d、7d发生升主动脉夹层。术后30d内死亡2例。术后30d内死亡率为67%。1例术后20个月因近端内漏接受第2次支架型人工血管植入术。术后随诊1～32个月,无死亡,亦无支架移位、狭窄等并发症。结论支架型人工血管是治疗主动脉夹层动脉瘤和主动脉穿透溃疡的有效方法,中远期效果还有待进一步观察。

Treating aortic dissection and penetrating aortic ulcer with stent-graft:30 cases

Objective:To evaluate the feasibility and safety of stent-graft in treatment of aortic dissection and penetrating aortic ulcer.Method:From June 2001 to April 2004,25 patients with aortic dissection and 5 patients with penetrating aortic ulcer received stent-graft implantation.There were 24 male and 6 female with average age of (52 3±11 9) years. There was 1 patient with Type A dissection, 23 patients with chronic Type B dissection, 1 patient with acute Type B dissection. Three of them had contained rapture. The other 5 patients were diagnosed as penetrating aortic ulcer. All patients were followed 1～32 months.Result:All patients received stent-graft implantation. There were 5 Type I endoleaks. Retrograde ascending aortic dissection occurred during operation in 1 case. Two other retrograde ascending aortic dissections occurred in two cases one day and seven days after stent-graft implantation respectively. Two patients died 1 day and 18 days after operation because of rupture of ascending aortic dissection. One month mortality was 6 7%. No death occurred during follow up time. One patient received a second stent-graft implantation 20 month after first procedure.Conclusion:Serious complication may develop after stent-graft implantation, but the early results of stent-graft treatment of aortic dissection and penetrating aortic ulcer were satisfactory. Long term follow up were needed.