Stanford A型主动脉夹层的腔内修复术后并发症分析

Complications after endovascular repair of Stanford type A aortic dissection

目的总结Stanford A型主动脉夹层(TAAD)腔内修复术后常见并发症的诊治经验。方法对2001年1月至2012年5月接受腔内治疗的58例TAAD患者资料进行回顾性分析。平均年龄54.3(41～79)岁。35例单纯接受腔内治疗,23例接受杂交手术:升主动脉-左颈总动脉-左锁骨下动脉旁路3例,左颈总动脉-左锁骨下动脉旁路3例,右颈总动脉-左颈总动脉旁路15例,左锁骨下动脉-左颈总动脉-右颈总动脉旁路2例。结果总技术成功率为98.3%(57/58)。并发症包括内漏14例,脑卒中5例,支架源性新破口1例,血管旁路术后吻合口假性动脉瘤2例。术后30天内死亡7例。随访(35.5±5.4)个月,随访期间死亡2例,其余患者均健康生存。结论 TAAD腔内治疗后并发症较累及降主动脉疾病的腔内修复术更为常见,脑卒中是重要的致死性并发症,应引起足够重视。

Objective To summarize the experience of the complications after endovascular treatment of Stanford type A aortic dissection (TAAD). Methods The data from 58 consecutive TAAD patients treated by endovascular aneurysm repair from January 2001 to May 2012 were analyzed retrospectively. The mean age was 54.3 (41～79) years. Direct stent-graft deployment was performed on 35 patients. Hybrid procedure was performed on 23 patients,including ascending aorta (AO)-left common carotid artery (LCCA)-left subclavian artery (LSA) bypass (n=3), LCCA-LSA bypass (n=3),right common carotid artery (RCCA)-LCCA bypass (n=15), LSA-LCCA-RCCA bypass (n=2). Results The technical success rate was 98.3% (57 / 58). The complications included endoleak (n =14), stroke (n =50), stent -graft induced new entry (n =1), bypass anastomotic pseudoaneurysm (n=2). All patients were alive except 7 perioperative death and another 2 death in the follow-up (average, 35.5±5.4 months). Conclusion Complications are more common in TAAD endovascular repair compared with that in descending aorta. Stoke is a significant lethal complication and should be attached importance.