胸主动脉夹层动脉瘤腔内隔绝术中移植物的选择

目的：为选择合适的用于胸主动脉夹层动脉瘤（TAD）腔内隔绝术（EVGE）的移植物（SG）提供参考。方法：根据我院116例手术经验、参考国外资料，对TAD进行EVGE术中应用不同SG的结构特点以及术后内漏和其他并发症情况进行总结。结果：应用了2类、3种SG系统。其中近端内漏12例，远端反流5例，肋间动脉反流1例，其他原因1例。6例出现背痛。中转手术1例，术后8d内死亡4例，其中2例存在内漏。结论；用于TAD的SG系统应具有一定的强度、良好的柔韧性及弹性；裂口距左锁骨下动脉开口较远时，适合直形SG；裂口距左锁骨下动脉开口较近时，弯曲SG更适合动脉解剖形态。裂口位于弓上或距离左锁骨下动脉开口＜1.5cm时，更适用带分支的SG。

How to choose appropriate stent-grafts in endovascular graft exclusion for thorocic aortic dissection

Objective:To provide reference for choosing the appropriate stent graft (SG) system in endovascular graft exclusion (EVGE) for thoracic aortic dissection (TAD). Methods:The cases of TAD managed with EVGE in our hospital were summarized. The different characters of the SG endoleaks, other complications, and the special SG mentioned in oversea documents were also analyzed. Results:Two styles(3 kinds) SG were used in our experience. Proximal endoleaks occurred in 12 cases, among which 4 tears located in the inner arc of the aortic arch descending aorta conjugating area. There were also 4 distal, one intercostal and one other reflux.Thoracic pain occurred in 6 patients. Conversion to conventional operation was performed on one patient. Four patients died in the peri operative period, among which 2 had leakages. Conclusion:Desired characteristics of the SG should have appropriate strength, good flexibility and elasticity. When the tear locates at far distal of the left subclavian artery, tubular SG is suitable. When it locates near the left subclavian artery, curved SG is the better choice, while on the aortic arch or the distance short than 1.5 cm, branched SG may be more suitable.