主动脉夹层动脉瘤腔内隔绝术中真腔进入困难的处理

To resolve the difficulties of entering into the aortic dissections′ ture lumen in endovascular graft exclusion

目的 探讨腔内隔绝术治疗StanfordB型胸主动脉夹层动脉瘤术中真腔进入困难的处理方法。方法 对1998年9月至2004年2月间施行的StanfordB型胸主动脉夹层动脉瘤进行回顾性研究。手术均在DSA监视下完成。其中28例出现导丝进入真腔困难, 4例出现导丝误入假腔再入真腔。术中使用的进入真腔的方法有:导管沿途造影法,夹层裂口多角度造影法,左肱动脉穿刺近端漂流法,真腔导入动脉选择法,导丝上下贯通法。结果 导管沿途造影法应用于32例患者,夹层裂口多角度造影法应用于12例患者,左肱动脉穿刺近端漂流法应用于10例患者,真腔导入动脉选择法应用于28例患者,导丝上下贯通法应用于2例患者。32例患者均成功导入真腔,支架型人造血管成功隔绝夹层裂口。结论 导丝进入真腔困难及误入假腔,会导致手术失败及支架型人造血管误放假腔的灾难性后果。利用多种血管腔内技术可以解决这一问题。

Objective To review the methods about resolving the difficulties of entering into the aortic dissections′ true lumen in endovascular graft exclusion. Methods The patients who had Stanford B type thoracic aortic dissection and been treated with endovascular graft exclusion from September 1998 to February 2004 were reviewed. The operations performed under DSA surveillance. In the operation, the wire was difficult to enter into the true lumen of the aortic dissection in 28 cases, and was wrong into the false lumen then into the true lumen in 4 cases. Five methods were used to resolve these problems, including catheter smoking technique, different position projection, left brachial artery puncture proximal guide-wire floating technique, arterial choice of entering into the true lumen and guide-wire transfixion between proximal and distal. Results The method of catheter smoking technique was used in 32 cases, different position projection in 12 cases, left brachial artery puncture proximal guide-wire floating technique in 10 cases, arterial choice of entering into the true lumen in 28 cases, and guide-wire transfixion between proximal and dista in 2 cases. The wires were ultimately successful to enter the true lumen and the stent-grafts excluded successfully the tears of the aortic dissections in 32 cases. Conclusion The difficulty of entering into the true lumen and the wrong way into the false lumen could lead to losing the operation, even a disaster. The problem could be resolved by some methods of endovascular techniques.