主动脉夹层覆膜支架腔内修复术围术期并发症分析

Perioperative complications of endovascular repair of aortic dissection

目的探讨主动脉夹层覆膜支架腔内修复术并发症的特点及预防处理措施。方法2001年6月至2005年5月，在我院行覆膜支架腔内修复治疗主动脉夹层78例。男性7l例，女性7例，平均年龄52．7±12．3岁（31～80岁），DeBakey Ⅲ型76例，DeBakey Ⅰ型2例。分析术中及术后30d内并发症的特点。结果78例患者共发生并发症15例，包括升主动脉夹层3例，发生率3．8％（3／78），分别在术中、术后第1天、第7天时发生，其中2例死于夹层破裂，心包填塞；急性肾衰2例，发生率2．6％（2／78），其中死亡1例；支架近端内漏5例，发生率6．4％（5／78）；术中脑梗塞1例，发生率1．3％（1／78）；术后脑出血1例，发生率1．3％（1／78），死亡；股动脉损伤1例，发生率1．3％（1／78）；肱动脉假性动脉瘤、左上肢-过性缺血各1例。其中术后死亡4例，死亡率为5．1％（4／78）。结论主动脉夹层腔内修复术严重并发症发生率较高，应予以充分的重视。

Objective To analyze the perioperative complications of endovascular repair of aortic dissection and to investigate their precautions and treatment. Methods Seventy eight aortic dissection patients hospitalized from June 2001 to May 2005 received endovascular repair. There were 71 males and 7 females with average age of （52.7 ± 12.3） years （31 - 80 years）. The 78 cases included 76 DeBakey Ⅲ dissection and 2 DeBakey Ⅰ dissections. The incidence and charateristies of complications during and 30 days after the operation were analyzed. Results Complications happened in 15 cases including three cases of ascending aortic dissections. The incidence rate of complications was 3.8% which occurred during the procedure, 1 day and 7 days after the operation respectively. Two cases died of cardiac tampenade due to rupture of the aortic dissection. There were 5 incomplete sealing of the primary tear. Two patients had acute renal failure and one of them died. One patient had acute cerebral infarction during the procedure. One patient showed cerebral hacmorrhage 7 days after endovascular repair and died. Femoral artery injury occurred in 1 patient and angioplasty was needed. One patient had left arm transient ischemia and one patient had pseudoaneurysm of the left brachial artery. A total of 4 cases deceased within 30 days after the operation and the mortality rate was 5.1%. Conclusion Perioperative complications of endovascular repair of aortic dissection were serious and show a relatively high occurrence rate.