Stanford B型胸主动脉夹层动脉瘤腔内治疗中期随访报告

Endovascular graft exclusion for Stanford B aortic dissection

目的 :总结腔内隔绝术治疗 Stanford B型胸主动脉夹层动脉瘤的中期疗效 ,探索该技术的临床应用前景。 方法 :对1998年 9月至 2 0 0 1年 12月间在本中心接受腔内隔绝术的 Stanford B型胸主动脉夹层动脉瘤患者 116例 ,按照术后 2周、3个月、6个月、12个月及以后每年 1次的方案进行随访 ,观察并发症及瘤体形态学变化。结果 :10 0例患者获随访 ,平均随访时间 (15 .4± 11.2 )个月 ,围手术期死亡 6例 ,随访中死亡 2例 ,2例术后再发 Stanford A型夹层行 Bentall手术后治愈。其余患者生存质量良好 ,无与 TAD及手术相关的并发症发生。6 7例术后随访 12个月以上者 CTA随访表明 ,夹层动脉瘤最大直径明显缩小 ,移植物位置、形态良好 ,瘤颈无显著扩张。结论 :腔内隔绝术治疗 Stanford B型主动脉夹层动脉瘤是一种创伤小、恢复快的新方法 ,中期的随访结果表明该技术安全、有效 ,内漏是该方法的主要并发症并可能导致术后患者死亡 ,该方法的远期疗效有待继续观察。

Objective: To review the midterm consequences of endovascular graft exclusion(EVGE) for thoracic aortic dissection, and to explore its clinical prospect. Methods: Since Sep. 1998 to Dec. 2001, EVGE for Stanford B type thoracic aortic dissection was preformed on 116 patients. The patients were followed up for 2 weeks, 3 months, 6 months, 12 months and then annually by spiral computerized tomographic scanning. The diameter of the aneurysms, the position and shape of the grafts were analyzed. Results: The mean follow up time was (15.4±11.2) months, 6 patients died within the perioperative period, 2 patients died during the follow up, 2 patients had recurrence of thoracic dissection(Stanford A) and cured by Bentall operation. The others were in good state, no complications related to the dissection and operation were observed. In 67 patients followed up for more than 12 months, thrombosis in false lumen was achieved in all patients, the aneurysmal diameter decreased obviously, the position and shape of the graft was improved. Conclusion: EVGE may be a safe and effective treatment for selected patients with thoracic aortic dissection. Endoleak may lead to aneurysmal expansion and rupture. Further follow up is necessary to evaluate its longterm effectiveness.