腔内治疗破口位于升主动脉的Stanford A型主动脉夹层

目的:总结腔内方法治疗破口位于升主动脉的Stanford A型主动脉夹层的经验。方法:回顾性分析6例破口位于升主动脉的Stanford A型主动脉夹层行升主动脉覆膜支架植入术或联合弓部分支重建术的患者临床资料。结果:所有患者全部成功施行手术,4例行升主动脉覆膜支架植入术,2例先行颈-颈动脉人工血管转流后再行升主动脉覆膜支架植入术。术后并发急性脑梗塞1例,急性心功能衰竭1例,呼吸功能不全2例。1例因夹层破裂出血术后1 d死亡,其余患者均安全出院。随访时间3~48个月,随访期间2例出现I型内漏,均未再接受手术继续随访。结论:对于一些不能耐受传统手术的高危患者,腔内治疗A型夹层以其微创的优势,可作为传统手术的替代方法挽救患者生命。

Endovascular treatment for Stanford type A aortic dissection with entrance tear in ascending aorta

Objective: To review the experience of endovascular treatment for Stanford type A aortic dissection with the entrance tear locating at the ascending aorta. Methods: The clinical data of 6 patients with Stanford type A aortic dissection an entrance tear at the ascending aorta who underwent ascending aortic stent-graft implantation or that combined with arch branch revascularization were retrospectively analyzed. Results: Procedures were successfully performed in all patients, of whom 4 cases underwent ascending aortic stent-graft implantation, and the other 2 cases underwent prosthetic carotid-carotid crossover bypass grafting prior to ascending aortic stent-graft implantation. After operation, acute cerebral infarction occurred in one case, acute myocardial infarction occurred in one case, and respiratory insufficiency occurred in two cases. One case died on postoperative day 1 due to hemorrhage from rupture of the aortic dissection, and the remaining cases were safely discharged. During 3- to 48-month follow-up, 2 cases developed type I endoleak, and were continuously followed-up without a second operation. Conclusion: For some high-risk patients who cannot tolerate traditional surgery, endovascular procedures by virtue of their minimal invasiveness can be used as an alternative approach to save their lives.