Stanford B型主动脉夹层发病24h内腔内修复术30例

目的 探讨Stanford B型主动脉夹层(aortic dissection,AD)发病24h内腔内修复术的疗效.方法 回顾性分析2007年6月至2008年1O月急诊行腔内修复Stanford B型主动脉夹层30例临床资料.本组腔内修复术均在胸痛症状出现后2.4h内完成;采用全身麻醉,在x线透视下将覆膜支架经股动脉放置在夹层第l裂口位置;其中1例第1裂口位于腹腔干对侧缘,运用开窗支架技术实施腔内修复术.术后1周、1、3、6、12个月行螺旋CT检查,观察手术疗效以及有无内漏、支架移位和内脏血供等.结果 30例支架均成功释放,无支架移位,无中转开胸手术,即刻造影I型内漏4例(13.4%),近端球囊扩张后3例消失,1例小于10%;所有患者真腔供血均得到改善.术后30 d死亡1例(3.3%),可能缘于术后夹层破裂;30例术后随访1-19个月,平均(12 4-8)个月,术后6个月发现1例(3.3%)I型内漏;无其他新发内漏出现.随访期间死亡1例(3.3%),该患者术后2月出现急性肝功能衰竭,死因不明.结论 24 h内腔内修复Stanford B型主动脉夹层可明显降低急性起病期患者死亡率,但远期效果还有待进一步观察.

Endovascular stent-grafts for acute Stanford type B aortic dissection

Objective To assess the results of emergency endovascular stent-grafting for patients with acute Stanford type B aortic dissection(type B AAD)within 24 hours of onset.Methods Between June 2007 and October 2008,30 patients with acute type B aortic dissection underwent emergency endOVascular stent-grafting within 24 hours of presentation.Under general anesthesia,stent-graft was deploved at the proper position of first tear entry through femoral artery under X-ray monitering.Follow-up by CT was performed 1 w,1 m ,3 m,6 m,1 y postoperatively to observe the efficacy and complications such as endoleak,migration and fracture of stent-graft. Result The technical success rate was 100%;13.4%(4 cases) endoleak rate was identified immediately after deployment.Follow up was made between 1 month to 19 months,averaging at(12±8)months,3.3%type-1 endoleak Was observed after 6 months;One patient died within 30 days possibly of dissection rupture;One patient died of acute liver failure during the follow-up. Conclusion Endovascular repair with stent-graft within 24 hours of presentation was effectivefor the treatment of acute type B aortic dissection.