Stanford B型主动脉夹层腔内治疗术后中远期并发症的治疗

Treatment of the mid- and long-term complications of endovascular repair for Stanford type B aortic dissection

目的探讨Stanford B型主动脉夹层腔内修复术(TEVAR)后中远期严重并发症的治疗及预防经验。方法分析2008年6月至2014年3月本院治疗的44例Stanford B型主动脉夹层TEVAR术后发生严重并发症患者的资料。结果主要并发症包括内漏、支架远端内膜撕裂、逆行夹层、脑梗死、支架移位、支架植入假腔、下肢缺血以及支架断裂。治疗方法为再次TEVAR治疗或开放手术治疗。34例患者痊愈,10例患者未愈。术后30天死亡率为2.3%(1/44)。随访时间2~45个月,平均23.5个月,并发症的总死亡率为6.8%(3/44)。死亡原因为脑梗死及主动脉瘤破裂。结论 TEVAR治疗Stanford B型主动脉夹层导致的并发症有不同的后续治疗问题。严格的术前评估,合适的支架选择及专业化的腔内手术技术能够减少这些并发症的发生。

Objective To describe the experience of the treatment of serious complications after primary thoracic endovascular aortic repair(TEVAR)in type B aortic dissection.Methods From June 2008 to March 2014,serious complications occured in 44 patients who recieved TEVAR for type B dissection. Results The complications included endoleak,distal true lumen collapse,retrograde dissection,stroke, stent-graft (SG) migration and mistaken deployment,lower limb ischemia,as well as SG fracture. The treatment included endovascular repair or surgical procedure.Thirty-four patients recovered from complications. Ten patients were not cured. Overall 30-day mortality was 2.3%(1/44). Mean follow-up period was 23.5 months(2~45 months),and the total mortality in our group was 6.8%(3/44). The causes of death were stroke and aorta rupture.Conclusion Some treatments need to be performed after TEVAR due to severe complications. A reduction in these complications could be achieved by optimal patient evaluation,SG selection and specialized endovascular manipulation.