不同术式入路对B型主动脉夹层腔内隔绝术的影响

The effect of different approach on thoracic endovascular aortic repair for Stanford B type aortic dissection

目的探讨不同术式入路对B型主动脉夹层腔内隔绝术的影响,评估使用预置血管缝合器行主动脉腔内隔绝术的可行性、安全性和有效性。方法 2010年5月-2012年6月收治69例B型主动脉夹层患者,经皮股动脉穿刺预置血管缝合器后行主动脉腔内隔绝术,为治疗组;对照组为2007年6月-2010年4月收治的86例B型主动脉夹层患者,经股动脉切开术行主动脉腔内隔绝术。治疗组根据移植物外径,20~24 F预置2把ProGlide;对照组缝合动脉切口时取出鞘管并将线结下滑收紧。比较两组手术成功率、手术操作时间、下肢制动时间、局部血管并发症、术后至出院时间、术后3个月手术部位血管直径变化率。结果治疗组68处股动脉穿刺口均使用2套Perclose ProGlide^(TM)血管缝合器,技术成功率为100%;对照组的86处股动脉,技术成功率为98.84%,组间差异无统计学意义(P>0.05)。手术时间及术后至出院时间治疗组分别为(85.42±20.65)min和(5.21±1.98)d,对照组分别为(145.28±32.68)min和(8.47±2.19)d,组间差异有统计学意义(P<0.05)。治疗组有2例发生血管并发症,明显低于对照组(8例)。治疗组下肢制动时间及3个月后血管直径变化率分别为(8.46±1.79)h和(0.98±0.24)mm,对照组为分别为(8.65±1.59)h和(0.95±0.32)mm,组间差异均无统计学意义(P>0.05)。结论应用预置血管缝合器行B型主动脉夹层腔内隔绝术安全高效,可显著缩短手术时间,有效减少局部血管并发症,是替代股动脉切开安全可行的方法。

Objective To discuss the effect of different approach on percutaneous endovascular aortic repair for Stanford B type aortic dissection, and to assess the feasibility, safety and effectiveness of preclose technique for the puncture and closure of femoral access sites. Methods A total of 69 patients of Stanford B type aortic dissection, admitted to authors＇ hospital during the period from May 2010 to June 2012, were used as the study group, and the patients received percutaneous endovascular aortic repair with preclose technique. Eight- six patients of Stanford B type aortic dissection, encountered at the hospital during the period from June 2007 to April 2010, were used as the control group, and the patients received pereutaneous endovascular aortic repair with femoral artery incision. In study group, based on the external diameter of the graft two 6-F Perclose Proglide devices were placed in the femoral artery before inserting 20 - 24 F sheath. In control group, the sheath was removed when the incision of the femoral artery was sutured. The technical success rate, procedure time, immobilization time of lower extremity, local vascular complications, hospitalization days from procedure to discharge, the diameter changes of treated vessels at 3 months after the treatment were compared between the two groups. Results No significant differences in baseline characteristics and endograft type existed between the two groups. The technical success rate was 100% in study group and 98.84% in control group. The procedure time and the hospitalization days fi＇om procedure to discharge in study group were much shorter than those in control group （85.42 ±20.65 rains vs. 145.28 ±32.68 rains, 5.21 ±1.98 days vs. 8.47 ±2.19 days, respectively, P 〈 0.05）. Compared with the control group, the incidenee of local complications was much lower in study group （2.94% vs. 9.30%, P 〈 0.05）. No significant differences in the immoifilization time of lower extremity and the diameter changes of treated vessels existed between the two groups. Conclusion By using preclose tet.hniqt,e with Perelose Pro（,lide device the percutaneous endovascular aortic repair is safe anti effective. The operation time as well as the loral vascular complications can be distinctively reduced. Therefore, this technique is feasihle anti can replace femoral artery ineision.（J lntervent Radiol, 2013, 22： 730-733）