人造血管覆盖支架成功治疗胸主动脉瘤9例报告

The treatment of thoracic aorta aneurysm by stent-graft T

目的 :报告 9例人造血管覆盖支架治疗胸主动脉瘤的结果。方法 :手术暴露股动脉 ,送入带距离标记的pigtail进行主动脉造影以确认人造血管覆盖支架的直径和长度。送入 30 0cm长的AmplatzSuperStiff导丝 ,切开股动脉 ,沿导丝送入人造血管覆盖支架 ,准确定位后 ,将收缩压降到 70～ 80mmHg(1mmHg =0 .133kPa) ,快速退出鞘管 ,释放人造血管覆盖支架 ,主动脉造影检查效果 ,最后缝合股动脉。结果 :共治疗了 9例降主动脉瘤 ,真性动脉瘤 4例 ,溃疡 1例 ,假性动脉瘤 1例 ,夹层 3例。除 1例夹层未能完全封闭假腔外 ,其余均隔绝动脉瘤获得成功 ,无 1例发生严重并发症 ,遇到的主要问题有 :1 动脉瘤非常靠近左锁骨下动脉 ,未能严密覆盖动脉瘤 ,发生了轻微的内漏 ;2 目前使用的人造血管输送系统比较硬 ,1例在主动脉弓部难以释放 ;3 测量不准 ,1例人造血管覆盖支架稍短 ,出现了轻微的内漏 ;4 夹层动脉瘤的治疗主要是封堵入口 ,1例入口和出口距离仅有 3～ 4cm ,故未能完全封闭假腔。结论 :置入人造血管覆盖支架可以隔绝真性动脉瘤 ,封堵夹层动脉瘤和假性动脉瘤入口 ,治疗效果好 ,操作简单 ,并发症少 ,出血少 ,恢复快。

Objective:Experience of 9 cases of the stent\|graft implantation to repair descending thoracic aortic aneurysm were reported.Methods:The femoral artery is exposed and punctured.Over a 0.035″ guidwire a marked pigtail catheter is placed in the ascending aorta to perform aortogram.A 300 cm long Amplatz super stiff wire is introduced through the pigtail catheter and the catheter is withdrawn.A cutdown is made on the femoral artery and an appropriate stent\|graft is inserted to the position.After correct positioning,systolic BP is reduced to 70～80 mmHg by I.V.nitroglycerin,and the sheath is quickly retracted to release the stent\|graft.Results:Nine cases of stent\|graft implantation were performed,including 5 cases of aortic aneurysm,1 aortic ulceration,1 false aneurysm,and 3 dissecting aneurysm.All but one dissecting aneurysm are successfully treated without major complication.The problems encountered in the procedures were:1.the aneurysm was not sealed completely because it was close to the origin of the left subclavian artery;2.delivering system was so rigid that the sheath was not retracted easily when the system was in the arch;3.the measurement was incorrect,which resulted in a small leak;4.in one disseoting aneurysm,the entry and reentry sites were only 3～4 cm apart,sealing of the entry did not obliterate the false lumen.Conclusion:the stent\|graft for treatment of descending thoracic aortic aneurysm is safe and easy.The complication is few. [