微创腔内隔绝术治疗降主动脉病变

目的总结微创腔内隔绝术治疗降主动脉病变的经验及近中期效果。方法分析总结本院2004年4月至2008年11月行腔内隔绝术27例患者的临床资料，其中急性Stanford“B”型夹层分离16例，降主动脉假性动脉瘤11例（包括5例外伤性降主动脉假性动脉瘤、5例降主动脉穿透性溃疡及1例感染性降主动脉假性动脉瘤）。结果26例患者手术获得成功，1例外伤性降主动脉完全断裂患者，因导丝无法进入升主动脉真腔，微创手术失败，转开胸手术行降主动脉替换。腔内隔绝术成功26例，术后降主动脉破口均立刻消失，真腔扩大。术后早期死亡1例（于术后2周死于胃溃疡大出血）；发生Ⅰ型内漏2例，Ⅱ型内漏1例；无术后截瘫、感染、远端血管损伤栓塞等并发症。腔内隔绝术成功26例患者中25例治愈出院。术后随访1个月～4年，覆膜支架通畅，无移位，真腔扩大，假腔缩小或消失。术后3个月CT复查，2例Ⅰ型内漏中1例内漏完全消失，1例内漏减轻（继续随访中），1例Ⅱ型内漏无变化。结论腔内隔绝术治疗Stanford“B”型夹层动脉瘤及降主动脉假性动脉瘤创伤小，安全可靠，近中期疗效确切。

Therapeutic effects of treating descending aortic aneurysm with endovascular graft exclusion(EVGE)

Objective To discuss the early and middle results and practical experience of the treatment of descending aortic aneurysm by endovascular graft exclusion （ EVGE ） with digital subtraction angiography （DSA）. Methods From April 2004 to November 2008, 27 patients were underwent the procedure of EVGE with DSA. 16 cases suffered from acute Stanford B aortic dissection and 11 ones with desending aortic false aneurysm. In 11 cases, 5 were with traumatic false aneurysm, 5 with penetrating aortic ulcer, one with infective false aneurysm. Result The procedure was technically successful in 26 patients, 1 case was turned to implant artificial vessel due to descending aorta complete rupture. 26 patients recovered and discharge in one to two weeks after operation, one died due to hemorrhage gastric ulcer after 2 weeks. Post operation, there was no severe complication occurred, Ⅰ type leakage occurred in 2 cases, Ⅱ type leakage in 1 case. They were followed up one month to four years. The Ⅰ type leakage was disappeared in one case, decreased in another one. There was no change in the patient with Ⅱ type leakage. The real cavity of all cases was enlarged and the pseudo - cavity was decreased or disappeared. Conclusion EVGE is effective and safe for the patients with descending aortic aneurysm. Early and middle results of EVGE in treatment of descending aortic aneurysm are satisfactory.