覆膜血管内支架置入治疗B型主动脉夹层的临床应用研究

Endovascular Stent-Graft Placement for Treatment of Type B Dissections

目的:评价覆膜血管内支架置入治疗B型主动脉夹层的疗效。方法:180例B型主动脉夹层,男158例,女22例,年龄(50．4±10．9)岁。术前行计算机体层摄影术(CT)增强扫描检查。在数字减影血管造影(DSA)监测下选用覆膜血管内支架封堵夹层原发破口。置入后即刻重复DSA检查。随访行胸部X线平片与CT增强扫描检查。结果:技术成功率99．4％(179／180),1例支架位置过高,行外科升主动脉-左颈总动脉-左锁骨下动脉搭桥术。术后即刻造影160例无内漏,18例少量内漏,2例中量内漏近段加短袖套支架(Cuff)后内漏消失;降主动脉真腔明显扩大,腹主动脉及分支供血均有不同程度的改善。术后随访(18．6±7．2)个月,18例少量内漏12例6个月内消失、6例无加重;21例支架段假腔消失,余者近端假腔内均有血栓形成;1例支架远端形成假性动脉瘤破裂死亡。结论:覆膜血管内支架置入治疗B型主动脉夹层安全有效,近、中期疗效满意,远期疗效有待于进一步观察。

Objective： To evaluate the safety and effectiveness of endovascular stent-graft placement for treatment of type B dissection. Methods： From April 2002 to December 2005,180 patients with type B dissection underwent endovascular stent-graft placement. There were 158 men and 22 women with mean age of 50. 4 ± 10.9 years. All patients were diagnosed by computed tomography（CT） or magnetic resonance imaging （MRI） scans. Stent-graft was deployed in the true lumen to occlude the entry tears after completion digital subtraction angiography（DSA）. Then DSA examination was repeated. X-ray and enhanced CT scaning were performed at follow-up. Results ： Stent-grafts were successfully placed in all patients except that one patient underwent surgical bypass grafting of ascending aorta-left carotid artery-left subclavian artery because of inappropriate stent-graft position. Immediately after procedures angiography revealed no endoleak in 160, minor endoleak in 18, and middle endoleak in 2 patients who showed no endoleak after additional Cuff. The diameters of descending aortic true lumen were significantly increased. Improvements of blood flow in distal aorta and abdominal branch-vessels were all achieved. During the follow-up of average 18.6 ＋ 7.2 months, CT scans demonstrated that 12 patients with minor endoleak were relieved and the other 6 patients were not deteriorated. False lumens disappeared in 21 patients at the levels of stents. There were thromboses developed in the thoracic aortic false lumen in the remaining patients. One patient died of aortic psuedoaneurysm. Conclusion： Endovaseular stent-graft placement is an effective treatment for type B aortic dissections in a short or middle period. Long-term results remain further observation.