摘要
目的 总结带膜血管内支架置入治疗DebakeyⅢ型主动脉夹层临床经验。方法 胸主动脉夹层 4 9例 ,男 4 4例 ,女 5例 ,平均年龄 (5 1 6± 1 8)岁。经CT增强扫描或磁共振成像确诊。切开右或左侧股动脉置入带膜血管内支架 ,封堵原发破口。置入后重复造影检查。随访行胸部X线平片与电子束CT检查。结果 支架置入全部成功 ,术后即刻造影 4 0例无内漏 ,9例见少量内漏。降主动脉及腹主动脉真腔均明显扩大 ,远端降主动脉及分支供血均有不同程度的改善。 1例因支架置入位置过高 ,行外科升主动脉 左颈总动脉 左锁骨下动脉旁路移植术。 1例术后死于中毒性休克。术后随访 :降主动脉及腹主动脉真腔扩大 ,术后造影 9例有内漏者 ,无加重 ,4例患者近端夹层动脉瘤消失 ,余者夹层近端假腔内均有血栓形成。结论 带膜血管内支架置入治疗胸主动脉夹层近期疗效满意 ,远期疗效有待于进一步观察。
Objective To investigate the clinic experience of endovascular stent-graft treatment for the thoracic aortic dissection. Methods Forty-nine patients with thoracic aortic dissection were diagnosed by contrast enhanced CT or MRI, including 44 men and 5 women and mean age (51.6±1.8) years. Vascular access was obtained through femoral artery after surgical arteriotomy and stent-graft was deployed in the true lumen to occlude the primary entry tear. Immediate aortography was performed after procedure and the follow-up data about X-ray and EBCT was evaluated. Results Stent-graft deployment was successfully performed. Immediate aortography after procedure showed no leakage in 40 patients and minor leakage in 9 patients. The diameters of thoracic and abdominal aortic true lumen increased significantly. Improvements of the blood flow in the distal aorta and abdominal branch-vessels were all achieved. One patient accepted the surgical by-pass graft of ascending aorta-left carotid artery-left subclavian artery for inappropriate position of the stent-graft, which affected the blood supply to the left carotid and subclavian artery. One patient died of toxic shock. The serial follow-up data demonstrated that true lumen of thoracic and abdominal aorta was enlarged and the leakage was not aggravated, the double-chamber of the thoracic aorta dissappeared in 4 patients and thrombosis in the thoracic aortic false lumen was exhibited in 45 patients. Conclusion Endovascular stent-graft deployment may be a satisfactorily effective treatment for thoracic aortic dissections. Further observation will be needed for evaluation of long-term results require.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2004年第2期141-143,共3页
Chinese Journal of Cardiology
