双源CT主动脉成像在DeBakey Ⅰ型主动脉夹层杂交手术前后评价中的价值

Dual source CT angiography in the pre-and post-hybrid surgery of DeBakey type I aortic dissection

目的:评价双源CTA在DeBakey I型主动脉夹层杂交手术治疗前后的应用价值。方法:回顾性分析11例夹层破口位于升主动脉或主动脉弓的DeBakey I型胸主动脉夹层患者行杂交手术术前及术后CTA,6例患者的术中DSA资料和CTA进行对照分析。结果:11例患者术前CTA明确诊断为DeBakey I型主动脉夹层,6例破口位于升主动脉根部上方附近,3例位于主动脉弓部,2例假腔机化,11例均累及胸主动脉及降主动脉,4例累及主动脉弓主要分支;术后CTA复查均很好显示置入支架位置,假腔血栓机化情况,重建主动脉弓及旁路血管显示清晰,其中2例患者左侧锁骨下动脉起始段闭塞,1例主动脉弓部局部出现内漏,其余患者夹层假腔内血栓机化,真腔内径扩大,旁路血管通畅。结论:双源CT主动脉成像在DeBakey I型胸主动脉夹层杂交手术前后的评价中有非常重要的价值。

Objective：The purpose of this study was to evaluate the value of dual source CT angiography（CTA） in the pre-and post-hybrid surgery of DeBakey type I aortic dissection.Methods：The pre-and post-treatment CTA data from 11 patients with DeBakey type I aortic dissection undergoing hybrid surgery were retrospectively analyzed;CTA and intra-operative DSA data from 6 patients correlated with CTA.Results：For all 11 patients,DeBakey type I aortic dissection was definitely diagnosed at pre-treatment CTA.Crevasse was localized in the upper part of the ascending aortic root（n=6）,the aortic arch（n=3）.Organized thrombus in the false cavity was shown in 2 patients.All 11 cases were involved in the thoracic and abdominal aorta,of which 4 cases involved in the branches of aortic arch.Post-operative CTA clearly showed the location of the stents,organized thrombus in the false cavity,reconstructed aortic arch and bypass vessels.Occlusion of the proximal segment of left subclavian artery was demonstrated in two patients,endoleak in one patient;organized thrombus in the false cavity,enlarged true cavity and patent bypass vessels in the remaining 8 patients.Conclusion：Dual source CT angiography plays an important role in the evaluation of the pre-and post-hybrid surgery of DeBakey type I aortic dissection.