I型主动脉夹层动脉瘤行全弓置换及术中腔内支架治疗的随访研究

A follow-up study of the patients treated by total arch replacement with an open stent graft for acute type I aortic dissection

目的总结34例急性I型主动脉夹层动脉瘤行全弓置换及术中腔内支架治疗后的随访结果。方法2005年1月至2010年10月，我院共为34例急性I型主动脉夹层动脉瘤的患者行全弓置换及术中腔内支架术治疗。术后门诊随访2—70个月，随访30例。分别于术后3-,12个月及其后每年随访1次增强CT，观察远端假腔内血栓形成或吸收以及假腔闭合情况。结果全组围术期死亡3例，病死率8．8％。随访期死亡1例。随访期所有患者远端覆膜支架处血管假腔均闭合，10例患者支架远端血管仍有假腔，但假腔直径均无明显增大。结论对于急性I型主动脉夹层动脉瘤的患者行一期全弓置换及腔内支架术可以增加术后远端假腔的闭合率，减少因假腔扩大可能引起的再次手术。

Objective To describe the follow-up data of 34 patients receiving total arch replacement with an open stentt graft for acute type I aortic dissection. Methods The subjects were 34 consecutive patients with type I acute aortic dissection （Twenty-eight males and 6 females, aged 34. 0 -46. 0 yrs） who received total arch replacement with an open stent graft in our hospital from Jan. 2005 to Oct. 2010. Thirty of the 34 patients were followed up for 2 - 70 months. CT scanning was performed at the 3 and 12 months and then yearly after operation to detect the thrombus formation, absorption of thrombus, and obliteration of the false lumen after its exclusion by the stent graft. Results Three patients died peri-operatively with the mortality of 8. 8%. One patient died during the follow-up period. Obliteration was recognized in all the patients at the distal side of the stent graft during the follow-up period. The false lumen remained in 10 patients at the distal part of descending aorta, but the diameter of the false lumen was not enlarged. Conclusion In patients with acute type I aortic dissection,it is relative safe to perform extensive primary repair of the thoracic aorta by stent grafting. This method may enhance the obliteration of the false lumen and reduce the possibility for further operations to manage a residual false lumen.