慢性B型主动脉夹层腔内治疗30例

Thoracic endovascular aortic repair for chronic type B aortic dissection in 30 patients

目的总结慢性B型主动脉夹层行腔内治疗（thoracic endovascular artery repair，TEVAR）的临床经验。方法回顾性分析2005年9月至2013年1月30例符合纳入标准的慢性B型主动脉夹层患者接受TEVAR治疗的临床资料。随访2～90个月，平均（33±25）个月。结果TEVAR的技术成功率为100％。在支架植入后的即刻主动脉造影中共有11例患者发现内漏。其中I型内漏3例，Ⅱ型内漏5例，Ⅳ型内漏3例。I、Ⅱ型内漏均得到了及时处理。没有发生围手术期死亡以及主要并发症。在随访期间，总计3例患者死亡，其中1例患者死于结肠癌，其余2例患者死于夹层相关再次手术的并发症。总计7例患者接受了再次干预。K—M生存曲线分析显示5年总体生存率为87．9％，5年无再次干预的生存率是72．8％。结论慢性B型主动脉夹层TEVAR治疗的近中期结果是令人满意的，是慢性B型主动脉夹层的有效治疗方式。

Objective To evaluate the results of thoracic endovascular aortic repair （TEVAR） for chronic type B aortic dissection. Methods From September 2005 to January 2013,30 patients with chronic type B aortic dissection received TEVAR. All patients were followed for 2 -90 months [ mean （33 ± 25 ） months ]. Results All of the procedures finally achieved technical success. However, during TEVAR, there were transient endoleaks in 8 patients including type I endoleaks in 3 patients, type II endoleaks in 5 patients and persistent endoleaks in 3 patients which are type IV endoleaks. Type I and type II endoleaks were successfully managed during the procedures. There was no mortality or major complication during the perioperative period. Three patients died during follow-up： one patient died of carcinoma of the colon and two patients died of the complications of secondary interventions related to aortic dissection. Totally there were seven patients receiving secondary interventions. The Kaplan Meier actuarial survival curve showed a 5-year survival rate of 87.9% and the 5-year survival rate without secondary intervention was 72.8%. Conclusions Early and midterm results showed that TEVAR was effective in treating chronic type B aortic dissection.