复杂主动脉夹层及胸主动脉瘤的腔内治疗

Endovascular repair for complicated aortic dissection and thoracic aortic aneurysm

目的总结复杂主动脉夹层(AD)及胸主动脉瘤(TAA)腔内隔绝术的治疗经验。方法共76例行腔内治疗的复杂AD及TAA病例,其中行单纯腔内隔绝术52例,结合烟囱技术的腔内隔绝术6例;结合支架近端开槽的腔内隔绝术5例;颈部杂交手术13例。结果围手术期死亡2例,其中1例患者术后4小时死于心跳骤停,1例杂交手术患者术后死于脑血管意外。51例得到随访,随访时间3个月至9年,平均18个月,1例TAA杂交手术患者人工血管全段闭塞,但患者无任何神经系统症状。2例患者分别在术后3个月及1年出现支架远端破口再行腔内隔绝术。1例AD患者术后6个月时出现支架近端新破口。在随访期死于肺癌和冠心病各1例。结论结合覆盖左锁骨下动脉、烟囱技术、开槽技术及颈部血管搭桥的腔内隔绝术,可提高复杂AD及TAA的疗效,降低并发症。

Objective To summerize the experience of thoracic endovascular aortic repair (TEVAR) in treatment of complicated aortic dissection (AD) and thoracic aortic aneurysm (TAA). Methods The clinical data of 76 cases with complicated AD and TAA treated by TEVAR were analyzed retrospectively, including 52 cases treated by simple TEVAR (left subclavian artery was covered in 22), 6 by TEVAR with chimney graft, and 5 by TEVAR with grooving stent and 13 by TEVAR with hybrid procedure. Results During the perioperative period,2 patients died. Of this two, one died of cardiac arrest after operation 4 hours and another one died of cerebrovascular accident postoperatively. Fifty-one patients were followed up with a mean time of 18 months(range,3 months and 9 years). One patient with TAA treated by hybrid operation developed total artificial vessel occlusion,but without any cerebrospinal symptoms.Two patients underwent second TEVAR after 3 months and 1 year because of the new tears distal to stent,respectively. The new tear proximal to stent was found in 1 patient after operation 6 months. And 2 patients with AD died of lung cancer and cardiac disease in the followed-up, respectively. Conclusion TEVAR with covering left subclavian artery, chimney graft, grooving stent and carotid artery hybrid (pathway) operation can improve effect and reduce complications in treatment of TAA and AD.