腔内支架人工血管治疗主动脉弓部动脉瘤

目的 探讨腔内支架人工血管治疗主动脉弓部动脉瘤的基本方法。方法 采用国产腔内支架人工血管治疗主动脉弓部动脉瘤患者46例,其中主动脉瘤累及主动脉弓中部23例(50％),单纯累及弓降部22例(48％),累及胸降主动脉1例(2％)。选择支架直径是夹层破裂口或瘤口近端相应部位主动脉直径宽的1．15～1．20倍。支架近端直径34～38mm,长度90～120mm。支架材料为国产形状记忆镍钛合金。结果 支架释放成功45例(98％),无远端动脉并发症发生。支架释放后即刻封闭瘤口或破裂口43例(96％),早期内漏2例(4％)。夹层真腔全部恢复正常。急性期患者中转手术1例,死亡2例。术后43例患者获随访,随访时间1～23个月,远期内漏3例(7％),但所有随访患者均恢复正常生活。结论 腔内支架人工血管可用于主动脉弓部动脉瘤的治疗,其治疗的长期效果还需进一步观察。

Endovascular stent-graft repair of aortic arch aneurysms: report of 46 patients

Objective To evaluate the basic procedure of endovascular stent-graft repair in the treatment of aortic arch aneurysm. Methods From March 2000-February 2002, a total of 46 patients with aortic arch aneurysms were treated with the custom-made endovascular stent-graft. Of them, twenty-three patients (50%) had aneurysms at the middle of the arch, 22 patients (48%) had aneurysms at the arch-descending aorta, and 1 patient (2%) had aneurysm at the descending thoracic aorta. The diameter of all stents was 0.15-0.25 times larger than that of the aorta proximal to the entry tear of dissection or the opening of aneurysm. The diameter of the proximal end of the stents was ranged from 34-38 mm. The length of stents ranged from 90-120 mm. The stent was made of shape memory nitinol. Results The stent was delivered successfully in 45 patients (98%). None of the patients had any access-related complications. Either the primary entry tear of aortic dissection or the inlet of aneurysm was occluded in 43 patients(96%), with an early endoleak in 2 patients (4%). All truth lumen of the dissection recovered to normal. Of the patients in acute period, 1 was refered to surgical repair and 2 died. Follow-up for 1 month to 23 months, showed late endoleak in 3 patients (7%). Forty-three patients restored normal life. Conclusions Endovascular stent-graft could be applied in the repair of aortic arch aneurysm. Further studies are needed to to assess the long-term efficacy of this method.