腔内修复术治疗复杂型Stanford B型急性主动脉夹层疗效分析

目的探讨腔内修复术治疗复杂型Stanford B型急性主动脉夹层(AAD)的安全性及有效性。方法回顾性分析自2002年4月至2016年2月于沈阳军区总医院心血管内科行腔内修复术治疗的99例复杂型急性Stanford B型AAD患者的临床资料,并分析其围术期特点及近、远期疗效。结果 99例患者均经腔内修复术治疗,98例成功植入支架,共植入支架104枚,其中,94例患者植入单支架,5例患者植入双支架。合并冠心病26例(26.3%),其中,7例(7.1%)合并严重冠状动脉狭窄,行经皮冠状动脉介入治疗,共植入冠状动脉支架8枚。7例(7.1%)患者在院死亡。在院期间无截瘫、脑卒中等并发症发生。77例患者获得随访,中位随访时间24个月。随访期间,9例(11.7%)患者死亡,其中,4例(5.2%)患者死于主动脉源性。1例(1.3%)患者因再发夹层再次行腔内修复术治疗。结论复杂型Stanford B型AAD病情凶险,预后差,应积极控制血压,进行主动脉腔内修复术治疗有利于降低病死率,有利于改善近远期预后,安全可行。

Endovascular repair of complicated Stanford B acute aortic dissection

Objective To evaluate the security and effect of endovascular repair(EVAR) of complicated Stanford B acute aortic dissection(AAD).Methods A retrospective study was performed on 99 cases of AAD patients with complicated Stanford B who were admitted from April 2002 to February 2016.Patients were treated with EVAR,the clinical characteristics of patients were collected,the perioperative characteristics and effects of short-term and long-term were analyzed.Results All the 99 patients underwent EVAR treatment,98 operations were successful,104 stents were implanted,including 94 cases of single-side stand and 5 cases of double-sides stand.There were 26 cases(26.3%) of combined coronary heart disease,including 7 cases(7.1%) of combined severe coronary stenosis who underwent percutaneous coronary intervention(PCI) with 8 coronary stents,7 cases(7.1%) died in hospital.There was no complications such as paraplegia and stroke.The 77 patients were followed up,median follow-up time was 24 months.During the follow-up period,9 cases(11.7%) died,including 4 cases(5.2%) of cardiac deaths and 1 patient(1.3%) with recurrent dissection treated with EVAR.Conclusion Complicated Stanford B AAD is dangerous,prognosis is poor,the blood pressure should be positively controlled.Therefore,endovascular repair is beneficial to reduce the fatality rate,is helpful for improving the prognosis of short-term and long-term,and is safe and feasible.