降主动脉瘤的腔内移植物治疗

Endovascular stent-grafting of descending thoracic aortic lesions

目的 探讨腔内移植物治疗降主动脉瘤的可行性。 方法 12例降主动脉瘤接受了血管腔内技术治疗 ,包括 5例真性动脉瘤、6例StanfordB型夹层动脉瘤及 1例假性动脉瘤。 13枚支架型血管在局部 (n =2 )或全身麻醉 (n =10 )下经一侧股动脉切开安装在病变部位。 结果 腔内技术成功率 10 0 %。无瘤体破裂、截瘫、脏器及肢体缺血等并发症。早期并发症 :3例早期内漏血。CT及MRA随访 1～ 30个月 :5例真性动脉瘤 4例被完全旷置 ,1例内漏转化为持续性。 6例StanfordB型夹层入口 4例一期封堵满意 ,2例少量内漏血自愈 ,4例假腔内完全血栓形成 ,2例部分形成。 1例假性动脉瘤效果满意。 结论 腔内移植物治疗降主动脉瘤是一种安全、可靠、实用的新方法。但其远期治疗效果有待继续观察 。

Objective To discuss the feasibility of endoluminal stent grafting for descending thoracic aortic lesions. Methods 12 patients underwent stent grafting of the thoracic aorta with Talent (11 patients) and Vanguard (1) device. Endovascular technique was used in 12 patients with descending thoracic aortic aneurysms (5 patients), Stanford B dissections (6), and pseudoaneurysm (1).13 straight stent grafts were inserted through 18 24 F theaths via a femoral arteriotomy under local (2 patients) or general (10) anesthesia. Results The procedure was technically successful in all patients without aneurysm rupture, paraplegia, and organs or limbs ischemia. There were 3 early andoleaks. Follow up showed that 4 of 5 aortic aneurysms were excluded completely and one endoleak was changed into persistent. Four entries of 6 patients with stanford B dissection were excluded and 2 early endoleaks were sealed during one month after operation. Four false lumen were filled completely and 2 false lumen were filled partly by thrombosis. Conclusion Descending thoracic aortic stent grafting is a safe, highly successful and feasible alternative to conventional surgery. The long term result remains unclear, especially that of the endovascular repair of Stanford B dissection.