慢性B型主动脉夹层腔内修复术84例

Thoracic endovascular aortic repair of chronic type B aortic dissection in 84 patients

目的 总结主动脉腔内修复术（TEVAR）治疗慢性B型主动脉夹层的临床经验.方法 2001年6月至2007年9月,84例慢性B型主动脉夹层病人接受了 TEVAR.从起病至实施TEVAR为1～120个月,平均（13.9±22.0）个月.随访6～86个月,平均（33.2±19.2）个月.结果 腔内修复术中,破口被完全封闭77例,内漏发生率为8.3%.1个月的病死率为1.2%.1例在术后1个月发生逆行A型主动脉夹层,行急诊升主动脉和主动脉弓置换术.4例实施了第2次TEVAR,其中3例为封堵内漏,另1例是覆膜支架远端出现新的内膜撕裂.7例在随访期内死亡（8.4%）,其中3例死于内漏引起的胸主动脉破裂,1例腹主动脉持续性扩张导致降主动脉破裂死亡,另2例死因与主动脉夹层无关,还有1例死因不详.K-M生存曲线分析显示7年生存率为84.4%.结论 早期和中期随访结果显示,TEVAR治疗慢性B型主动脉夹层是有效的.内漏是随访期的主要死因.随着外科医师经验的积累以及覆膜支架的改进,TEVAR会有更好的疗效.

Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair （TEVAR） of chronic type B aortic dissection. Methods Methods From June 2001 to September 2007, 84 patients with chronic type B aortic dissection received TEVAR. The time between onset of dissection and TEVAR was （13.9 ± 22.0） months （ranged 1 - 120 months）. All patients were followed for 6 - 86 months [mean （33.2 ± 19.2） months]. Results The entry tear was completely sealed in 77 cases （ 91.7% ） during TEVAR. The incidence of incomplete seal was 8.3%. One-month mortality was 1. 2%. One patient had retrograde type A dissection 1 month after operation. Four patients received a second TEVAR during follow-up ：3 for endoleaking and 1 for newly formed intima tear. Seven patients （8.3%） died during follow-up： 3 thoracic aorta rupture due to endoleaking, 1 abdominal aorta rupture caused by continuous dilation of the abdominal aorta, unrelated to aortic dissection deaths in 2 and 1 died of unknown cause. The Kaplan Meier actuarial survival curve showed a 7-year survival rate of 84.4%. Conclusion Early and mid-term results showed that TEVAR was effective in treating chronic type B aortic dissection. Endoleak was the main cause of death during follow-up. With increasing of physician＇s experience and refinement of the stent-graft, results are likely to improve in the future.