腔内隔绝术治疗Stanford B型主动脉夹层210例分析

目的评价腔内隔绝术治疗Stanford B型主动脉夹层的疗效和安全性。方法收集2002年4月至2010年10月于沈阳军区总医院行主动脉腔内隔绝术治疗Stanford B型主动脉夹层210例资料,年龄(53.4±11.1)岁。经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后造影检查证实疗效;合并严重冠状动脉狭窄者于腔内隔绝术后3～7 d完成经皮冠状动脉介入治疗(PCI)。观察介入治疗的疗效。结果腔内隔绝术成功率100%,共置入208枚主体覆膜支架及13枚cuff支架。20例患者完全封闭左锁骨下动脉开口,无左上肢及脑供血不足症状。26例患者行PCI成功率100%,对32支靶血管共置入36枚冠状动脉支架,无出血、心肌梗死等并发症。患者术后平均随访(60±35)个月,随访率96.6%(201/208)。33例出现腔内隔绝术后综合征,13例术后有残余内漏,其中8例残余内漏于术后3个月自行封闭。术后半年,3例再发升主动脉夹层,1例发生截瘫。术后1年,1例发生迟发性内漏。行PCI患者无主要心脏不良事件发生。本组共死亡6例,其中与腔内隔绝术有关死亡4例,分别发生在术后1 h、术后5 d、出院后2 d、15 d,与腔内隔绝术无关死亡2例,分别问胃癌晚期和肺心病。结论腔内隔绝术治疗Stanford B型主动脉夹层近期及长期疗效好、并发症低。合并冠心病患者择期二次行PCI安全可行。

Endovascular repair of Stanford B aortic dissection in 210 patients.

Objective To evaluate in-hospital and long-term results of endovascular repair of Stanford B aortic dissection by stent graft. Methods From April 2002 to October 2010,210 patients with Stanford B aortic dissection underwent stent graft implantation.Their average age was 53.4±11.1 years.The anterior walls of femoral artery were cut and the stent grafts were placed to close dissection tears.The patients with coronary heart diseases were implanted with stent graft 3~7 days before they underwent PCI.The clinical effects were analyzed. Results Procedures were technically successful in all patients.A total of 208 trunk stent grafts and 13 cuff stent grafts were used.In 20 patients,left subclavian artery was thoroughly covered by the proximal section of the graft,without any ischemic symptoms of the left upper limb and brain.Thirty-six stents were placed to 32 target vessels in 26 patients.The success rate of PCI procedure was 100%,with no severe complication such as bleeding.The average follow up was 60±35 months,and the follow up rate was 96.6%(201/208).Transient post-implantation syndrome occurred in 33 patients.Endo-leak occurred in 13 patients,with 8 closed in 3 months.Ascending aortic dissection occurred in 3 patients and paraplegia occurred in 1 during 6 months.Late endo-leak occurred in one patient during 1 year.Totally 6 patients died,4 related to endovascular repair at 1 hour,5 days after operation,and at 2 days,15 days after discharge.Another 2 patients died of gastric cancer and pulmonary heart disease. Conclusion In-hospital and long-term results of endovascular repair are satisfactory in treatment of Stanford B aortic dissection,with less complication.Combination technique of endovascular repair and PCI is safe and feasible that treating Stanford B aortic dissection with coronary heart disease.