血管腔内移植物治疗大动脉疾病的探讨

目的探讨以血管腔内移植物为主的血管腔内疗法治疗胸或胸腹主动脉疾病的疗效和存在问题。方法治疗包括夹层动脉瘤、真性和假性胸主动脉瘤、主动脉减速伤和缩窄患者共137例。主要病变的最低部位在腹腔动脉和肠系膜动脉之间。除血管腔内治疗法外,尚辅以腹主或髂动脉-肠系膜上动脉、或腋动脉-左颈总动脉等架桥术。结果发生急性内脏动脉缺血而急症开腹手术2例。早期漏7例。围手术期死亡6例(4．4％)。随访1～43(平均11)个月,发现后期内漏2例、血管腔内移植物部分断裂1例。DeBakeym型夹层治疗后发生Ⅰ型夹层病变1例。后期死亡5例(4例与腔内移植物无关,1例为多发性动脉瘤复发),失访11例,115例存活。结论以血管腔内移植物治疗高风险的大动脉病变相对安全有效,具有发展前景;但器材有待改进、远期疗效有待观察。

Exploration on endovascular treatment for disorders of great vessels

OBJECTIVE: To explore the efficacy and shortcoming of endovascular therapy with mainly endovascular graft in treating disorders occurring in the thoracic or thoracoabdominal aorta. METHODS: Total 137 cases with great vessel disorders including dissections, aneurysm, pseudoaneurysm, aortic deceleration injury and coarctation were treated by endovascular technique. The lowest lesion located between the celiac and mesenteric arteries. RESULTS: Two cases underwent emergent surgery due to acute visceral arterial insufficiency. Seven cases had early endoleaks. After a follow-up of 1 - 43 (average of 11) months, 2 late endoleaks were detected; 5 patients died, 4 of them were due to endograft unrelated diseases, one due to a recurrent multiple aneurysms. CONCLUSION: Endovascular treatment is relatively safe and effective for treating high risky patients with lesions occurring in the great vessels and seems to have a prospective future, although the device needs to be further improved and the long-term efficacy should be confirmed.