胸主动脉夹层腔内隔绝术后内漏的分型及意义

Classification of the endoleaks after endovascular exclusion for thoracic aortic dissection and its significance.

目的 探讨胸主动脉夹层腔内隔绝术后内漏的分型及其意义。方法 97例主动脉夹层行腔内隔绝术。移植物释放定位成功后进行主动脉DSA ,术后 7～ 10天行螺旋CT ,分别评估内漏的来源及量的多少 ,决定内漏的处理。近端多量内漏时 ,在近端附加延伸移植物置入 ,少量内漏暂不处理 ;移植物针孔内漏暂不处理 ;远端内漏根据量的多少决定处理方式。结果 12例近端内漏中 ,10例多量内漏经附加延伸移植物将内漏封闭 ,2例少量近端内漏未处理。 5例远端反流及针孔内漏均在观察中。结论 根据内漏的来源 ,可将内漏分成 4型。正确分型将有利于判断。

Objective To evaluate the method of classification of endoleaks after endovascular exclusion for thoracic aortic dissection and the significance of it.Methods Ninety-seven consecutive cases of thoracic aortic dissections (TAD) underwent endovascular exclusion (EVE). Aortography by digital subtracting angiography (DSA)was done after the stent-graft had been deployed and anchored, and spiral CT detection seven to ten days postoperatively was done. The volume of the endoleak was evaluated for the decision making. When large volume of endoleak exists, an additional stent graft is deployed to seal it, while nothing was done to the small volume one. A distal reflux or thread hole was also left to follow up.Results Twelve proximal endoleaks occurred. Among them, ten with large volume were sealed by extension, two were left for follow-up. All the other endoleaks of distal reflux and thread hole were in follow-up, too.Conclusion Endoleaks can be classified into four types according to the origins and directions. Accurate classification of them is helpful for the judgement, management and standard comparison.