整体式分支型覆膜支架治疗Debakey Ⅲ型主动脉夹层

Treatment of DeBakey Ⅲ aortic dissection with domestic branched endovascular stent-graft

目的:探讨整体式分支型覆膜支架治疗DebakeyⅢ型主动脉夹层的临床疗效。方法:对16例De-bakeyⅢ型主动脉夹层患者进行血管腔内覆膜支架修复。所有患者都进行了16排螺旋CT增强扫描,确诊夹层原发破裂口位于左锁骨下动脉开口以远,距左锁骨下动脉开口平均距离1.2(0.5～1.8)cm。患者发病平均时间为7.6(2～15)d。所有患者都采用整体式分支型覆膜支架修复夹层破裂口,经股动脉顺序置入支架于左锁骨下动脉和主动脉弓降部。支架主干直径34～46mm,分支直径12～16mm,支架长度110～120mm。结果:16例支架均一次释放成功,夹层破口完全封闭,真腔血流正常,左锁骨下动脉血流通畅。术后平均随访1～2年,无并发症发生,无手术死亡。结论:采用整体式分支型覆膜支架治疗DebakeyⅢ型主动脉夹层,可在急性期行覆膜支架置入术,当近段锚定区小于2cm时,可保持分支动脉血流通畅,近期效果良好,长期结果仍需进一步观察。

Objective：To investigate the efficacy of domestic branched endovascular stent-graft for DeBakeyⅢ aortic dissection.Method：Sixteen patients with DeBakeyⅢaortic dissection were diagnosed by contrast-enhanced CT scanning at 2-15 day from onset.The distance from the orifice of left subclavian artery to primary entry tear point was less than 2cm.Domestic branched stents were placed into left subclavian artery and the arch of aorta. Result：Stent-graft was successfully performed in all patients.All ruptures were completely closed.The blood flow in the true lumen and the left subclavian artery returned to normal.There were no complications during the 1to 2-year follow-up.Conclusion：Domestic branched endovascular stent-graft is a safe,reliable and effective choice for acute aortic dissection.However,further follow-up is necessary to evaluate its long-term efficacy.