Stanford B型主动脉夹层腔内修复术后发生夹层及手术相关性死亡12例分析

Dissection-or operation-related death following thoracic endovascular aortic repair for Stanford type B dissection:an analysis of 12 cases

目的分析应用胸主动脉腔内修复术(TEVAR)治疗Stanford B型主动脉夹层后发生夹层及手术相关性死亡的主要原因,并探讨其相应的防治方法。方法收集2000年8月—2008年6月在复旦大学附属中山医院血管外科完成的650例Stanford B型主动脉夹层TEVAR术后发生夹层及手术相关性死亡的12例患者的临床资料,分析其死亡的原因及相应的防治方法。结果TEVAR术后发生夹层及手术相关性死亡12例(1.8%,12/650),男9例,女3例,年龄35～68岁,平均年龄为(53±11)岁。6例死于并发新发破口,其中5例位于人工血管内支架(简称支架)近端,引起逆行性A型夹层;另1例位于支架远端,导致假腔进行性增大;另6例中死于缺血性脑卒中3例,主动脉夹层破裂1例,内张力1例,支架释放失败1例。结论Stanford B型主动脉夹层TEVAR术后夹层及手术相关性死亡的发生率较低,导致死亡的原因以支架两端新发破口最为常见,采取相应的防治措施具有积极意义。

Objective To analyze the causes for dissection- or operation-related death after thoracic endovascular aortic repair （TEVAR） for Stanford type B dissection, and to discuss the preventive methods. Methods A total of 650 patients with type B dissection underwent TEVAR from Aug. 2000 to Jun. 2008 in our hospital. Of them 12 patients, including 9 men, 3 women （mean age [53 ± 11] years, ranging 35-68 years） died due to dissection- or operation-related reasons and their clinical data were retrospectively analyzed to know about the specific causes and the preventive measures. Results The death rate of the present group was 1. 8% （12/650）, Among the 12 death cases, 6 were due to development of new entries （5 at the proximal end causing retrograde type A dissection, 1 at the distal end resulting in persistent enlargement of the dissecting aneurysm）, 3 due to ischemic stroke, 1 due to rupture, 1 due to endotension, and 1 due to failure of endograft release. Conclusion The incidence of dissection- or operation-related death is low after TEVAR in patients with type B dissection, and development of new entries at the either end of the endograft is the most common cause of death~ pertinent preventive measures may be of great help for the outcomes of patients.