复杂B型主动脉夹层术后远端再发内膜破裂诊治回顾

Diagnosis and Treatment of Distal Intima Rupture after the Repair of Stanford Type B Aortic Dissection: A Case Report and Literature Review

目的探讨B型主动脉夹层腔内隔绝术后远端再发内膜破裂的机制与防治。方法回顾性分析1例B型主动脉夹层术后远端再发内膜破裂的临床资料,并复习相关文献。结果患者因B型主动脉夹层在外院经腔内膈绝术治疗后效果不佳,转入我院。从最初发病到并发症的出现的3年内,共发生了2次支架远端再发内膜破裂及1次支架近端Ⅰ型内漏。在外院及我院先后行2次开胸手术、2次腔内隔绝术,病情恢复良好,随访1.5年病情稳定。结论主动脉夹层腔内隔绝术后远端再发内膜破裂的预防与治疗重点在于选择正确的手术入路、适合的覆膜支架及远端限制性裸支架,以保障手术安全性。

Objective To investigate the mechanisms, prevention and treatment of distal intima rupture after the re- pair of Stanford type B aortic dissection. Methods Clinical data of one patient with distal intima rupture after the repair of Stanford type B aortic dissection was retrospectively analyzed, and related literature was also reviewed. Results The patient occurred type B aortic dissection, and was transferred to our hospital after ineffective endovascular graft exclusion. During ini- tial onset to complication occurrence within 3 years, the patient occurred distal intima rupture twice and proximal type ｜ en- doleak once. The patient had undergone thoracotomys twice and endovascular repairs twice after admission in our hospital, and the patients recovered well, and then the patient~ condition was stable with one and a half years of follow-up. Conclusion Correct choice of surgical approach, suitable covered stent-graft and placement of restrictive bare stent play an important role in the prevention and treatment of distal intima rupture after the repair of Stanford type B aortic dissection.