应重视升主动脉夹层腔内修复术的规划与实施

Attach importance to the planning and implementation of endovascular repair for ascending aorta dissection

自2000年Dorros等报告了国际上第一例腔内修复术治疗升主动脉夹层之后,学者们渐渐探索出了一种新的升主动脉夹层治疗方式.升主动脉位置和形态学特点比较特殊,在应用腔内修复术时应注意如下几点：（1）根据适应证合理针对患者特点个性化选择治疗方式;（2）充分进行术前评估;（3）选择合理的支架与输送系统;（4）选择合理手术入路;（5）术中保证冠状动脉及弓上分支动脉的灌注并保护主动脉瓣的功能;（6）精确定位支架位置;（7）加强中远期随访.总之,应用腔内修复术治疗升主动脉夹层,应把握手术适应证和技术要点,严格根据患者特点合理选择治疗方式,避免治疗误区,提高手术安全性.

Since 2000 Dorros et al.reported the first case of type A aortic dissection （TAAD） treated with an endovascular repair, surgeons explored a novel treatment option for TAAD gradually.The application of endovascular repair for TAAD highlights some points below which should pay attention to because of the special anatomic location and morphological characteristics of ascending aorta： （1） customized treatment strategy based on the characteristics of patients;（2） pre-operation evaluation;（3） selection of the stent and delivery system;（4） selection of the access sites;（5） preservation of the coronary artery flow, aortic valve function and perfusion of the branch vessels;（6） accurate location of stent-graft;（7） mid-term and long-term follow-up.In a word, it＇s helpful to avoid misunderstanding in treatment and improve the safety of operation by grasping the indication and the technical points and making the customized treatment strategy based on the characteristics of patients.