血管内支架置入术治疗Stanford B型主动脉夹层

Endovascular Aortic Stent-graft Placement for Treatment of Stanford Type B Aortic Dissection:Experience of 15 Cases

目的:总结主动脉血管支架置入术治疗StanfordB型主动脉夹层的临床经验。方法:术前对15例StanfordB型主动脉夹层患者进行主动脉全程薄层增强CT扫描及血管成像,以获得主动脉夹层病变解剖学特征。在局麻下行主动脉造影,并与CT结果比较,选取支架血管型号。全麻下切开左股动脉或右股动脉,置入支架血管,封堵原发破口,重复造影检查有无内漏。术后1周及1年行CT随访,观察有无内漏、支架移位和假腔变化。结果:15例均获临床成功。1例见少量近端内漏,未发生其他并发症。CT随访,5例主动脉夹层消失,余者假腔内血栓形成。结论:与传统手术相比,腔内隔绝术治疗StanfordB型主动脉夹层具有创伤小、并发症少、安全性高等优点,近期疗效满意。

Objective：To introduce the experience of endovascular stent-graft placement for treatment of 15 cases of Stanford type B aortic dissection. Methods：Contrast-enhanced thin-slice CT was performed preoperatively to obtain the anatomical characteristics of the aortic dissection. Aortography was performed under local anesthesia. The size of the endovascular stent-grafts were chosen according to consensus of aortic CT and aortography. Vascular access was obtained through femoral arteriotomy and stent-graft was placed in the true lumen of the aorta to occlude the primary intimal tear under general anesthesia. Immediate aortography was performed after placement of the stent-graft to demonstrate if there existed any endoleak. Follow-up CT angiography 1 week and 1 year postoperatively was used to evaluate treatment efficacy. Results： Clinical success was achieved in all 15 cases. Immediate aortography revealed minor endoleak in one case, no other complications occurred. Follow-up CT showed that the false lumens disappeared in 5 cases and were filled with thrombus in the other patients. Conclusion：The short- and mid-term efficacy of endovascular stent-graft therapy for Stanford type B aortic dissection is satisfactory with less invasiveness and definite safety.