DeBakey Ⅰ型主动脉夹层动脉瘤的血管腔内治疗

目的探讨血管腔内治疗DeBakeyⅠ型主动脉夹层动脉瘤的方法。方法对7例DeBakeyⅠ型主动脉夹层动脉瘤进行血管腔内治疗。7例均行磁共振血管造影、CT和动脉造影检查确诊。内膜撕裂口均位于升主动脉,距冠状动脉开口2．5-6．0cm,距右头臂干开口0．5-4．0cm。2例通过左颈总动脉置入带膜支架,术前行左锁骨下动脉-左颈总动脉间内转流术以保证左颈总动脉血供。5例通过右股总动脉置入带膜支架,其中2例先行左锁骨下动脉-左颈总动脉-右颈总动脉人工血管旁路术。结果全组均手术成功。3例第1枚支架释放后仍有较多内漏,即再放入第2枚支架,交错重叠于第1枚支架内面而成功封闭撕裂口,消灭内漏。除1例术后1个月因急性上消化道大出血死亡外,其余6例存活。6例的假腔均有血栓形成,无内漏,无新的夹层动脉瘤形成。结论DeBakeyⅠ型主动脉夹层动脉瘤的血管腔内治疗是可行、微创和有效的。病例选择应注意撕裂口距冠状动脉开口的距离。

Endovascular stent-graft treatment for DeBakey I aortic dissection

OBJECTIVE: To study endovascular treatment of DeBakey type I aortic dissecting aneurysm. METHODS: Seven patients with DeBakey I aortic dissecting aneurysms were treated. Diagnoses were confirmed by MRA, CT and angiography. The intimal tear entry was in the ascending aorta, 2.5 approximately 6.0 cm from the ostia of the coronary arteries, and 0.5 approximately 4.0 cm from the brachiocephalic trunk opening. Endovascular stent-grafts were deployed via a left common carotid artery (LCCA) approach in 2 cases and right femoral artery (RFA) approach in 5 cases. Prior to treatment, a left subclavicular artery (LSA)-LCCA shunt was established to ensure blood supply to the LCCA during surgery in 2 cases via LCCA approach, and a LSA-LCCA-right common carotid artery (RCCA) synthetic bypass was established to ensure blood supply to the brain in 2 cases in RFA approach. RESULTS: The operative success rate was 100%. In 3 cases, endoleak persisted after the first stent was placed, but this was eliminated by placement of a second stent. All patients survived except one who died of acute massive hemorrhage from the upper gastrointestinal tract one month postoperatively. The false lumen in all 6 cases became thrombosed and no endoleak or new aortic dissecting aneurysms developed. CONCLUSIONS: Endovascular treatment of DeBakey type I aortic dissecting aneurysm is feasible, minimally invasive, and effective. Case selection depends on the distance of the coronary artery ostia from the tear entry.