破口位于主动脉弓降部的逆撕StanfordA型主动脉夹层的腔内修复治疗

Endovascular repair for retrograde type A aortic dissection with an entry tear in the descending aorta

目的探讨原发破口位于主动脉弓降部，假腔逆撕累及升主动脉的StanfordA型主动脉夹层的腔内修复治疗方法。方法回顾性分析2006年4月至2012年12月，中南大学湘雅二医院血管外科采用主动脉覆膜支架腔内修复技术治疗的31例逆撕StanfordA型主动脉夹层患者的临床资料。22例合并胸腔积液，14例升主动脉假腔内有活动性血流。2例分别合并急性右肾动脉缺血和急性右下肢缺血，采取急诊腔内手术；29例在保守治疗2～3周后腔内手术治疗，3例采用“烟囱”技术重建左颈总动脉。结果手术成功率100％，未发生升主动脉新发破口、脑卒中，I型内漏等。术后2周升主动脉内活动性血流消失，升主动脉内假腔明显缩小，胸主动脉真腔管径明显恢复；升主动脉术后1～3个月重塑完全，假腔完全消失。术后3～21d，胸腔积液逐渐吸收。术后随访（31±18）个月，无严重并发症发生，“烟囱”支架均保持通畅。结论主动脉覆膜支架腔内修复技术能够用于破口位于主动脉弓降部的StanfordA型夹层的治疗。“烟囱”技术能辅助重建主动脉弓部分支动脉。

Objective To evaluate endovascular aortic repair for retrograde Stanford type A aortic dissection with an entry tear in the descending aorta. Methods From April 2006 to Dec 2012, 31 patients with retrograde type A aortic dissection were treated with endovascular technique. 22 patients had pleural effusion, 14 patients had patent false lumen in the ascending aorta. Emergency operation was performed in 2 patients with acute right renal artery and right common iliac artery ischemia respectively. 29 patients received endovascular treatment after 3 weeks conservative treatment. Chimney technique was used in 3 patients. Results All procedures were technically successful without severe complications. Ascending aorta recovered 1 -3 months after operation. Pleural effusion subsided 3 days to 3 weeks after endovascular treatment. During follow-up of （31 -＋ 18） months, no severe complications developed, all the stent-grafts placed by chimney technique were patent. Conclusions Endovascular aortic repair can be used in the treatment of retrograde Stanford type A aortic dissection. Chimney technique can be used to reconstruct supra-aortic branches.