覆膜支架治疗降胸主动脉瘤

目的评估覆膜支架治疗术治疗Stanford B型主动脉夹层和降主动脉瘤的安全性和近期疗效。方法2003年3月至2005年9月期间,共29例Stanford B型主动脉夹层和2例降胸主动脉瘤患者接受覆膜支架治疗术,所有患者均有高血压病史,其中急性发病27例.本组采用两种支架(Mdtronic Talent15例,上海微创Aegis 16例),术后采用CTA进行定期随访。结果所有支架均成功按预期定位释放,术后即刻DSA复查显示23例夹层患者近端破裂口完全封闭,2例降主动脉瘤也完全隔离,6例发现有内漏;术后7 d CTA复查发现16例假腔内完全血栓形成,12例近端假腔形成血栓,远端假腔仍开放。结论覆膜支架术治疗Stanford B型主动脉夹层和降主动脉瘤安全、有效,可替代外科手术。但覆膜支架术的确切长期疗效尚待进一步的大样本、前瞻性对照研究才能确定。

Endoluminal stent-graft management for type B aortic dissection and descending thoracic aortic aneurysm

Objective To evaluate the feasibility and short-term early results of endoluminal stentgraft placement in the Stanford B type aortic dissection and the descending thoracic aortic aneurysms.Methods From March 2003 to September 2005,a total of 31 patients underwent placement of endovascular stent-grafts,including the descending thoracic aortie aneurysm(n=2) and Standford B type aortic dissection(n=29).All patients had hypertension,with urgent onset of progressive thoracic pain in 27.Two kinds of stent-graft were used in this series: the Talent(Medtronic) in 15 and Aegis(Microportmedicine,Shanghai) in 16 patients.Follow-up was carried out with clinical observations and CTA. Results Stent-graft implantation for the proximal entry closure was successfully performed in all patients.The DSA of immediately post deployment of the stent-graft showed complete occlusion the proximal entry tear in 23/29 patients with dissection,and complete isolation of the aneurysm in two patients with aortic aneurysm.Endoleak was revealed in 6 patients with dissection.No major complications related to the procedure were encountered.Conclusions The interventional placement of stent-graft for Type B aortic dissection and descending thoracic aortic aneurysm is safe with satisfactory short-term outcomes.Nonetheless,longer follow-up is highly desirable to assess its real advantages.