Stanford B型主动脉夹层腔内隔绝术后主动脉重塑的特点及影响因素

Influential factors of the aortic remodeling in Type B aortic dissection with endovascular graft exclusion

目的:分析Stanford B型主动脉夹层腔内隔绝术(EVGE)后主动脉重塑影响因素并探讨亚急性期行此术式后主动脉重塑的特点。方法:对44例Stanfo rd B型主动脉夹层患者行EVGE治疗,术后采用CT扫描进行随访。根据支架段假腔是否消失分为2组。测量术前CT扫描图像中支架近、中、远段水平假腔径线及总径线,分析性别、高血压、手术时机、支架类型等对主动脉重塑的影响。将亚急性期患者主动脉分为A1、A2、A3段,观察3段主动脉中点所在平面真、假腔及瘤体直径的变化情况。结果:术前CT扫描各径线比较,假腔消失组均低于假腔未消失组;亚急性期行EVGE与急性期及慢性期比较,假腔消失组病例数高于假腔未消失组;夹层累及腹主动脉较未累及者,假腔消失组病例数低于假腔未消失组;术后6个月内A1、A2段瘤体及真假腔重塑变化较明显(真腔增大、假腔变小),而A3段在术后重塑变化不显著(真腔稍增大、假腔稍减小)。尤其亚急性期行EVG E后连续CT观察:真腔逐渐增大,假腔逐渐减小,6个月内趋于闭合。结论:术前假腔直径、长度以及支架置入时期的不同是影响术后主动脉重塑重要因素。亚急性期行EVGE有利于主动脉重塑。

Objective： To analysis of influentia Type B aortic dissections, and to elucidate the aortic underwent EVGE. Methods： EVGE for Stanford B factors of the aortic remodeling in patients with remodeling pattern of subacute aortic dissection thoracic aortic dissection were preformed in 44 patients. All patients were followed by contrast enhanced CT. All patients were divided into two groups according to whether the false lumens were disappeared. Firstly, the diameters of the false lumens and aortas proximal within and distal to the stents were analyzed. Secondly, the 8 factors of sex, hypertension operative opportunity, type of framened were compared. Thirdly, subacute aorta was divided into three segments A1, A2 and A3. The diameters of aortic aneurysm, true lumen and false lumen in the middle above the three segments were measured. Results： The preoperative di- ameters of false lumen disapperaed （group 1） was lower than that of false lumen appeared （group 2）. The analysis of 8 factors showed： the subacute stage was a positive factor and dissection ex- tending beyond the diaphragm was a negative factor. The aortic remodeling pattern showed： the segments A1 and A2 remodeling were evident. In segment A3, remodeling was not so evident after operation. Conclusion： The main influential factors of the aortic remodeling includes the staging of EVGE, dissection extending beyond the diaphragm and the preoperative diameter of false lumen. EVGE is a safe and effective treatment for subacute Stanford B aortic dissection.