带膜血管内支架植入治疗主动脉夹层对腹部血管分支供血的影响

Transluminal Stent-graft Placement for the Treatment of Aortic Dissection: Its Effect on Abdominal Blood Flow

目的 探讨带膜血管内支架植入 (TSGP)治疗主动脉夹层对腹部血管分支血供的影响。资料与方法 2 4例DebakeyⅢb型主动脉夹层接受TSGP治疗 ,分析手术前、后影像学资料 ,比较其腹部主要血管分支影像学变化。结果 2 4例共计 96支腹腔内脏主要血管分支 (包括腹腔动脉、肠系膜上动脉及左右肾动脉 ) ,经术前CT、MRI与DSA资料综合判断 ,血流受损血管 37支 ,其中 9支为动力型受损 (占 9.4 % ) ;2 8支为静力型血流受损 (占 2 9.2 % )。TSGP后血流受损的分支血管影像学显示均有不同程度血流改善 ,无术后缺血并发症发生。结论 TSGP不仅能改善Ⅲ型主动脉夹层所致的血管分支动力型缺血 ,对静力型受损的血管也有明显的即时血流改善作用 ,但中远期效果有待进一步观察。

Objective To discuss the effect of transluminal stent-graft placement (TSGP) for the treatment of aortic dissection on the abdominal blood flow. Materials and Methods Twenty-four patients underwent TSGP for Debakey Ⅲb aortic dissection. The blood flow of abdominal vascular branches before and after the procedure was estimated and analyzed.Results A total of 96 important vascular branches of abdominal aorta was observed with CT, MRI, and DSA. Thirty-seven branches were affected before interventional procedure, of which 9 (9.4%) were dynamic impairment and 28 (29.2%) were static impairment. After TSGP, the blood flow of impaired vessels showed an improvement of different degree. No postoperative ischemic complications occurred.Conclusion TSGP can improve not only the dynamic but also the static ischemia of the abdominal aortic branches cause by Debakey IIIb aortic dissection. Further study is needed to clarify the mid-term and long-term effectiveness of TSGP.