TEVAR手术支架直径选择与相关并发症的防治

Selection of stent diameter and the prevention and treatment of complications in TEVAR surgery

目的探讨腔内胸主动脉修复（TEVAR）手术支架直径选择与相关并发症的防治问题。方法回顾性分析新疆维吾尔自治区人民医院2006年1月-2013年4月218例接受TEVAR手术患者的病例资料，对其中178例术后患者进行中期随访。结果178例患者中，18例在腔内治疗后支架远端及近端出现新破口或内漏。1例“逆撕”患者曾拟行封堵器封堵，但因破口较大，未能成功，目前该患者随访至今；12例出现支架尾部破口的患者采用覆膜支架对接，其中10例患者使用了限制性支架；近端内漏5例患者，其中2例再次随访时内漏消失，3例患者采用直径较大覆膜支架再次封堵，内漏消失。术后围手术期无死亡，178例患者获得随访，随访时间10-36个月，平均随访（25．6±8．4）个月，在随访过程中木发现并发症。结论术前准确测量主动脉弓直径对选择合适直径的支架和提高支架的稳定性、降低内漏的发病率很重要，远端限制性支架对于真腔狭小及预防远端支架相关的破口并发症的发生有积极地防治作用。

Objective To explore the diameter selection of TEVAR surgical stent and investigate the prevention and treatment of complications. Methods To retrospectively analysis the clinical data of 218 cases（patients） with aortic TEVAR operation in the Xinjiang Autonomous Region People＇s Hospital from 2006 January to 2013 April, of which 178 cases were follow-up in the medium term. Results A new break or endoleaks in distal and proximal stent in the 18 patients with endovascular treatment, one cases of ＂reverse tear＂ patients had underwent occlude closure, but the break is too large, we can not succeed, and the patients was followed up to date. Five patients with Proximal endoleaks, 2 patients endoleaks has disappeared, 3 patients were larger diameter stent graft closure again, and endoleaks have disappeared. 12 cases of breach bracket tail patients who were treated with stent graft docking, and 10 patients using restrictive bracket. There are no death in perioperative, all patients were followed-up and rate was 100%. The follow- up period is 10-36 months, mean follow-up time is （25.6 ± 8.4） months, and there are no complications dewing follow- up. Conclusions Accurate measurement of the diameter of the aortic arch to select the appropriate diameter of the stent is also very important to improve the stability of the stent to reduce the incidence of type fistula. Remote restrictive bracket have certain value for small true lumen of the breaches and preventing the formation of distal stent .