胸主动脉夹层动脉瘤腔内治疗中导入动脉几种处理方法的比较

目的：比较总结Stanford B型胸主动脉夹层动脉瘤（TAD）腔内隔绝术中不同导入动脉处理方法的优缺点。方法：对1998年9月至2001年12月间在本中心接受腔内隔绝术的Stanford B型胸主动脉夹层动脉瘤患者116例进行回顾性分析。11例患者采用局部肝素化加导入动脉完全阻断法，5例采用全身肝素化加导入动脉完全阻断法，99例采用全身肝素化加导入动脉部分阻断法，1例采用导入动脉吻合人工血管的方法。结果：导入动脉完全阻断的患者在下肢血流复通后血压显著下降且伴有代谢性酸中毒，其中局部肝素化的患者术后下肢并发血栓形成2例，筋膜间隙综合征2例。导入动脉部分阻断法失血量增加，但下肢并发症减少。结论：在TAD腔内隔绝术中以部分阻断法处理导入动脉既可减少术中的血压波动又避免了术后严重的下肢并发症。

Comparison of access artery management during endovascular graft exclusion for Stanford B type aortic dissections

Objective: To compare the different access artery management methods during endovascular graft exclusion(EVGE) for Stanford B type aortic dissection. Methods: From Sep. 1998 to Dec. 2001, EVGE for Stanford B type thoracic aortic dissection have been preformed on 116 patients, among them 11 underwent local heparinization and total stump of the access artery, 5 patients underwent general heparinization and total access artery stump, 99 underwent general heparinization and partial access artery stump, 1 underwent artificial vascular anastomosis. The blood loss and complications related to the access artery were compared between different methods. Results: There was an obvious decrease of blood pressure and metabolic acidosis after the access artery reperfusion in the total stumped access artery, and 2 femoral artery thrombosis occurred in the local heparinization patients. The blood loss obviously increased in the partial stumped access artery patients, but no lower extremity complications occurred. The artificial vascular anastomosed to the femoral or iliac artery as access artery resulted in few blood loss and lower extremity complications. Conclusion: General heparinization and partial stump of the access artery has more advantages, it avoids blood pressure wave and decreases extremity complication totally. The artificial artery is more complicated and is used only in the patients need exchanging catheter frequently.