复杂型主动脉夹层的腔内治疗

Endovascular therapy for complicated aortic dissection

目的探讨复杂型主动脉夹层腔内血管外科治疗方法。方法对2 5例复杂型主动脉夹层行腔内血管外科治疗患者的临床资料进行回顾性研究。结果2 5例患者年龄3 1-7 6岁,平均5 2.6岁。2 5例中6例术前合并肠管缺血,5例合并肾动脉缺血,3例既有肠管缺血又有肾动脉缺血,5例腹主动脉真腔完全被假腔压闭,4例合并下肢缺血,2例合并腹主动脉瘤。所有患者进行了腔内血管外科治疗,并取得了技术上的成功。2例合并腹主动脉瘤的夹层患者予以支架型人工血管封闭夹层破口后行开腹腹主动脉瘤切除人工血管置换术。术后内漏3例(2例漏血7 d后停止,1例漏血持续存在);其余2 2例患者术后即时造影示瘘口已被完整覆盖,假腔无血漏入,内脏动脉等恢复真腔供血。前述的合并症术后均逐渐恢复,无脏器及肢体缺血坏死发生,患者均痊愈出院。结论对复杂的主动脉夹层的治疗,腔内治疗与传统的手术相比,操作简单、损伤小、安全度大、并发症少,且可大大缩短患者的住院时间。腔内血管外科技术上的改进,使复杂的主动脉病变得以成功的治疗。

Objective To explore the method of endovascular therapy for complicated aortic dissections. Methods The clinical data of 25 patients with complicated aortic dissections were analysed retrospectively. Results The patients＇ ages ranged from 31 - 72 years with a mean of 50.2 years. Among the 25 cases, 6 cases had severe ischemia of mesenteric artery, 5 cases had renal artery ischemia, 4 cases had severe isehemia of both legs, 3 cases had renal arteries ischemia combined with superior mesenteric artery ischemia, 2 had complicated aortic dissection combined with AAA, and in 5 cases the true aortic lumen was totally compressed by the false aneurysmal lumen. All patients underwent endovascular therapy, and the instant technique was successfully performed in all patients. Endoleak occurred in 3 cases after the stent-graft deployment, it stopped spontaneously in 2 of them 7 days later, and 1 case with endoleak waiting for treatment. In the other 22 patients, angiography after the operation showed that all the diseased area were sealed completely, and the viscera arterial blood supply was restored mainly via the true lumen. All the patients were cured and discharged. Conclusions In the management of complicated aortic dissections, endoluminal technique is simple, less traumatic, safe and has less complications as compared to the traditional operation. Improvement of the endoluminal technique is essential for successful treatment of these complicated cases.