带膜支架腔内隔绝术治疗主动脉夹层初步体会

The Preliminary Understanding of Endovascular Stent-graft Exclusion Forthe Treatment of Aortic Dissection

目的：探讨带膜支架腔内隔绝术治疗主动脉夹层的安全性和有效性。方法：6例主动脉夹层患者,增强螺旋CT、MRI诊断：5例为DebakeyⅢ型,1例为DebakeyⅡ型。先行升主动脉造影（左前斜45°）及腹主动脉造影（正位）,明确诊断,确定破口位置,然后选择合适的带膜支架,准确定位后释放,记忆合金支架自动张开封闭破口。结果：4例典型主动脉夹层DebakeyⅢ型患者,应用带膜支架成功封闭破口。术后真腔扩大,假腔内血栓形成。随访5～12个月,支架位置及形态均未见明显改变,假腔内血栓渐机化。结论：与传统的经胸人工血管置换术相比,带膜支架腔内隔绝术治疗主动脉夹层具有简捷微创、患者术后恢复快、并发症和死亡率低的优点。目前,对于近期疗效已得到认可,对其远期疗效的评价尚有待于进一步随访。

Objective：The study aims to explore the safety and effectiveness of endovascular stentgraft exclusion（EVGE） for the treatment of aortic dissection. Methods：six eases of aortic dissection patients. Enhanced Spiral CT and MRI diagnosis：five eases of type Ⅲ Debakey,one eases of Type Ⅱ Debakey. First operating ascending aortic angiography （left anterior oblique 450） and abdominal aortic angiography （orthophoria） determine learning a clear diagnosis,determine the location of rupture. Then choose the appropriate stents,after the release of accurate positioning, the automatic memory alloy stent closed the rupture. Results： 4 eases of aortic dissection Debakey typical type Ⅲ patients,being applied coated stents successfully closed the rupture. The real cavity expands,thrombus formation in the false cavity. Makes a follow-up visit for 5-12 month, the stent location and the shape has not seen the obvious change and the thrombus organize gradually in the false cavity. Conclusion： Compare with the traditional transthoracic prosthetic vessel replacement,the endovascular stent-graft exclusion for the treatment of aortic dissection is simple while minimally invasive, patients recover quickly, complications, mortality are lower. At present, the effect has been recently recognized, the evaluation of its long-term effect would be given in further follow-up.