腔内修复术治疗胸主动脉夹层动脉瘤

目的 探讨应用支架人工血管行腔内修复术治疗胸主动脉夹层动脉瘤的临床效果.方法 回顾性分析采用腔内修复术治疗胸主动脉夹层动脉瘤32例患者的临床资料.男26例,女6例;平均年龄61岁.术前根据CTA结果 确诊,并对病变部位及解剖条件进行评估.手术在DSA监控下进行,全麻或局麻,应用Telent 8例(美敦力公司),国产支架24例(2例上海微创,22例北京裕恒佳).结果 7例破口距左锁骨下动脉开口＜1.0 cm,3例将覆膜支架跨过左锁骨下动脉开口将其封闭后,夹层动脉瘤消失,无上肢及脑缺血症状.治愈31例,死亡1例.31例夹层动脉瘤患者随访3～56个月均健在,其中5例CTA复查有内漏存在.结论 EVAR手术为夹层动脉瘤的治疗开辟了一个新的方法 ,具有比传统手术并发症少、病死率低等优点.在Stanford B型夹层动脉瘤的治疗中,EVAR可代替传统的开胸手术.

Endovascular repair for thoracic dissecting aneurysm

Objective:To study the clinical effects of endovascular stent-graft repair for thoracic aortic aneurysm (TDA).
Methods :The clinical records of 32 patients with thoracic aorta dissecting aneurysm, including 26 men and 6 women, who underwent endovascular repair were retrospectively analyzed. The characteristics,location,and anatomic condition of dissecting aneurysm were evaluated using CTA before operation. Under general or local anesthesia,32patients underwent endovascular repair under dynamic DSA. For those patient, 8 Talent,22 Yuhengjia(Beijing) and 2 Microinvasive(Shanghai) stent grafts were used.
Results: Among them 32 patients the distance between  entry tear and left subclavian artery was <1.0 cm in 7 patients, and the left subclavian artery was sealed by grafts in 3 patients after which, the anearysm disappeared and with no ischemia of brain or upper limbs in any of the patients, One of 32 patients with TDA died,and the other 31 patients were alive and well at followed up for 3 to 56 months,  but endoleak occurred in 5 patients discovered by CTA.
Conclusions:Endovascular stent graft repair for aortic anearysm is less invasive, has low complication and mortality rate, and is suitable for old high-risk patients. EVAR can replace conventional open operation for Stanford B dissecting aneurysm.