腔内覆膜支架治疗B型主动脉夹层对腹部分支血管供血的影响

The effect of transluminal stent-graft placement on blood flow of abdominal branch vessels in type B aortic dissection

目的探讨覆膜血管内支架置入术对主动脉夹层腹部重要血管分支血流的影响。方法35例B型主动脉夹层接受覆膜血管内支架治疗,通过术前后电子束CT、MRI与DSA资料分析,比较术前后腹部重要血管分支影像学变化。结果35例共计140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),术前经影像学资料综合判断,血流受损血管58支,其中14支为动力型受损,占10.0%(14/140支);44支为静力型血流受损,占31.4%(44/140支)。覆膜血管内支架置入后14支动力型受损的血管分支血流全部改善;44支静力型分支均显示不同程度血流改善,管腔狭窄程度减轻,对比剂充盈和排空速度加快,术后无缺血并发症。结论覆膜血管内支架置入术不仅能改善B型主动脉夹层所致的血管分支动力型缺血,对多数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 evaluate the effect of TSGP on blood flow of abdominal branch vessels of Type B dissection. Methods Thirty-five patients with type B aortic dissection underwent TSGP. The blood flow of abdominal branch vessels was analyzed via EBCT, MRI, and DSA before and after procedure. Results A total of 140 important vessels from abdominal aorta in 35 patients, including celiac artery, SMA, right and left renal arteries were analyzed via EBCT, MRI, and DSA. 58 branches were affected by dissection, of which 14(10%) were dynamic impairment; and 44(31.4%) were static impairment. After TSGP, the blood flow of impaired branches all showed improvement at different degrees, no post-operative ischemic complications occurred. Conclusion TSGP could improve the blood flow immediately not only the dynamic but also the static ischemia of abdominal aorta branch vessels caused by type B aortic dissection. Further study is still need to observe the mid-term and long-term effect of TSGP.