支架象鼻术后支架远端破口的腔内修复治疗

Intervention for distal stent graft-induced new entry after stented elephant trunk operation

目的总结采用覆膜支架腔内置入治疗支架象鼻术后支架远端破口的临床经验。方法2011年10月至2013年4月，11例主动脉夹层行支架象鼻术后支架远端破口患者采用覆膜支架腔内修复治疗。患者均为男性；年龄33～69岁，平均（47±7）岁。自股动脉送入覆膜支架，与原术中支架重叠释放，隔绝支架远端破口。所用覆膜支架均为渐细支架，渐细范围为4～6mm，覆膜支架近端直径为28～32mm，远端直径为24—26mm，长160～200mm。如远端锚定区真腔过小或主动脉弯曲弧度较大，可预先在拟锚定区置入1枚合适的裸支架，覆膜支架近端与原术中支架对接释放，远端位于裸支架内，以避免再次发生支架远端破口。本组4例采用了覆膜支架加裸支架的方法。结果所有患者均成功完成覆膜支架置人治疗，成功封堵夹层破口，无术中并发症发生。无围术期脑卒中、截瘫发生。术后1例患者因主动脉破裂死亡。生存的10例患者均定期随访，随访期内无卒中、截瘫，无死亡。计算机体层扫描血管成像检查支架形态、位置良好，无移位、内漏发生，未见支架远端新发破口。结论降主动脉覆膜支架置人术治疗支架象鼻术后支架远端破口效果良好。覆膜支架加裸支架可有效避免再次发生支架远端破口。

Objective Distal stent graft-induced new entry t is one of the complication of stented elephant trunk operation, to introduce our experiences that the covered stent has been applied to close distal stent graft-induced new entry. Meth- ods From Octomber 2011 to April 2013, 11 patients suffering from distal stent graft-induced new entry have accepted inter- ventional treatment with the covered stent, they were all male patients. Covered stent was transported from the femoral artery in- to position of new entry, the covered stent was released and overlapped the stent elephant trunk graft to seal stent distal new en- try. If the true lumen at the distal anchorage area is too small or curvature of the aorta is relative!y large, a bare stent should be implanted to the intended anchorage area firstly, then the covered stent was implanted, the approach of covered stent and bare stent was used for 4 patients. Results The covered stents were implanted in all patients successfully with no perioperative complications. Aorta angiography showed that the covered stents are in proper positions and the distal stent graft-induced new entry were sealed successfully. No perioperative stroke or paraplegia occured in this group, one patients died of aorta rupture. Follow-up have been completed for the other 10 patients. During the follow-up, no stroke, paraplegia and death occurred, CTA examination showed that the stents were in proper forms and positions without any displacement and endoleakage. Conclusion To treat distal stent graft-induced new entry with implantation of covered stents for descending aorta can achieve a good therapeutic effect. The approach of using covered stent together with bare stent could effectively avoid distal stent graft-induced new entry happening again.