B型主动脉夹层覆膜支架治疗前后主动脉造影的表现

Aortographic manifestations of type B aortic dissection before and after stent-graft implantation

目的 观察和研究B型主动脉夹层覆膜支架置入前后的造影表现 ,为判断预后和决定治疗提供参考。方法 回顾性分析 1999年 8月到 2 0 0 3年 5月于我院就诊的 4 8例B型主动脉夹层患者主动脉造影结果。结果 除 1例外 ,所有患者可以见到真假腔。入口多在主动脉弓和降主动脉的交界处 ,但 5例在左锁骨下动脉开口处 ,4例在降主动脉的下段 ,2例在腹主动脉 ,出口在腹主动脉或在髂动脉。假腔的血流有 6种情况 :(1) 34例 (71% )的假腔既有入口又有出口 ,入口和出口之间的假腔通畅 ,假腔的直径略大于真腔 ,且血流略慢于真腔 ;(2 ) 1例 (2 % )的假腔只有入口没有出口 ,4 %的假腔只有出口没有入口 ;(3) 4例 (8% )的假腔内部分血栓形成 ,入口和出口之间不相通 ,但入口和出口分别有血流从真腔进入假腔 ;(4) 6例 (12 % )的假腔入口和出口通畅 ,假腔呈瘤样扩张 ,真腔被挤压变细甚至闭塞 ;(5 )置入覆膜支架后封堵了假腔的入口 ,血液不再从入口进入假腔 ,假腔因此缩小而真腔扩大 ,真腔的血流增多加快 ,狭窄或闭塞的分支血管开放 ,但出口变成了入口 ,血液从出口进入假腔 ;(6 ) 1例 (2 % )的假腔内完全血栓形成 ,入口和出口被封闭。沿途的血管分支被假腔压迫狭窄或闭塞 ,或被假腔撕断。结论 主动脉造影显示假腔的

Objective The aortograms before and after the stent-graft in type B dissection has revealed some important new pathophysiological findings. Methods Aortograms of fourty-eight patients with type B dissection were retrospectively analyzed. Results (1) Aortograms showed the true and false lumen. Most of the entry tear was located around 3 cm distal to left subclavian artery. The entry tear was located just at the ostium of the left subclavian in 5 patients, at the mid descending aorta in 4, at the abdominal aorta in 2. The aortogram showed 6 false lumen flow patterns: (1) 71% of the false lumen was patent with entry and reentry, and the false lumen was equal with true lumen in size; (2)2% of the false lumen had only entry without reentry; (3)8% of the false lumen was partially thrombosed between entry and reentry; (4)12% of the false lumen was aneurismally dilated. (5) After stent-graft, the entry was completely sealed with disappearance of false channels in 33 patients, only a trace of contrast entered the false lumen in 10 patients. A large amount of contrast entered the false lumen due to incomplete coverage in 5 patients; (6)2% of the false channel was completely thrombosed. Conclusion Aortography showed 6 false lumen flow patterns, which is probably helpful in predicting prognosis and planning stent graft implantation.