腔内隔绝术治疗胸主动脉夹层的诊疗策略

The strategy of diagnosis and treatment of endovascular graft exclusion in treating thoracic aortic dissection

目的分析腔内隔绝术(EVGE)治疗胸主动脉夹层(AD)及其术前诊断的经验,为临床AD诊疗提供帮助。方法回顾性分析该院226例AD的临床资料、治疗及随访结果,所有患者在介入室行EVGE治疗,术后即刻数字减影血管造影(DSA)复查,并常规行CT血管造影(CTA)随访复查。结果 CTA与MRA对破口位置的诊断符合率分别为96.8%和95.2%;治疗1例失败,其余225例成功置入支架,成功率达99.6%,术后造影93.8%(211/225)的夹层裂口完全封闭或内漏显著减少,术中无严重并发症及死亡发生。结论 AD的术前影像诊断可首选CTA和MRA,对手术入路的选择有重要意义,EVGE在治疗AD创伤小,成功率高、恢复时间短、疗效较好。

Objective To analyse the preoperative diagnose and treatment experience of applying endovascular graft exclusion （EVGE）curing thoracic aortic dissection（AD） ,thus provide experience of diagnose and treatment for cure AD in clinical .Methods Review the clinical data ,therapeutic measures and follow‐up results of 226 AD patients .All patients were treated by EVGE ,coun‐terchecked by DSA post‐operation and reviewed .Results CTA and MRA in the diagnosis of crevasse position coincidence rate was 96 .8% and 95 .2% respectively .One case failed ,the remaining 225 cases were successfully placed graft ,success rate was 99 .6% .It showed that 93 .8% （211/225） complete disappearance of the false lumen or remarkable decrease of the endoleak was noted on the angiograms after stent implantation .No severe procedure‐related complications and death was observed .Conclusion CTA and MRA are important for us to choose appropriate routes ,can be the first choice of pre‐operation examination .EVGE is small trauma , short recovery time and effective in curing AD .