带膜支架腔内修复联合解剖外旁路术治疗Stanford A型主动脉夹层

Endovascular stent-graft repair for Stanford type A aortic dissection with extra-anatomic bypass

目的探讨带膜支架腔内修复联合解剖外旁路术对 Stanford A 型主动脉夹层的临床效果。方法通过建立各种解剖外旁路来重建无名动脉、左颈总动脉或左锁骨下动脉以延长锚定区,然后一期或分期行带膜支架主动脉腔内修复术;可采取颈动脉入路或股动脉入路来完成主动脉腔内修复术。结果全组34例中升主动脉夹层8例,主动脉弓部夹层26例,除1例术中死亡外,其余33例均成功接受带膜支架主动脉腔内修复术。30d 病死率为8.8%(3/34),内漏发生率为11.8%(4/34),脑梗死发生率为5.9%(2/34)。随访6～70个月,平均24.5个月,2例失访。结果显示假腔内完全血栓形成16例,部分血栓形成13例。结论带膜支架腔内修复联合解剖外旁路术为 Stanford A 型主动脉夹层提供了一种新的治疗方法,具有微创、安全性较高,并发症较少的特点,但应注意适应证的选择。

Objective To evaluate the effects of endovascular stent-graft repair for Stanford type A aortic dissection combined with extra-anatomic bypass. Methods To perform endovascular repair for Stanford type A aortic dissection, we tried to extend the landing zone by extra-anatomic bypass to reconstruct the innominate artery, the left common carotid artery or the left subclavian artery, and then achieved the process immediately or at a secondary stage via either the carotid or the femoral approach. Results Thirty- four patients with ascending aortic dissection （ n = 8） and aortic arch dissection （ n = 26） were treated with this technique. Thirty three patients were successfully done aortic endovascular repair, only one died during the operation. The thirty-day mortality rate was 8.8% （3/34）, endoleak incidence rate was 11.8% （4/34） and incidence rate of cerebral infarction was 5.9% （2/34）. Twenty-nine patients were followed-up for 6-70 months （ mean, 24. 5 months）. Complete （ n = 16） and partial （n = 13） thrombosis of the false lumen were showed with CT angiography and/or vascular color Doppler ultrasound scanning. Conclusions Endovascular stent-graft repair combined with extra-anatomic bypass can be a novel option for Stanford type A aortic dissection; it is safe, less invasive, and with fewer complications. Nevertheless, indications need further consideration.