正逆向技术在复杂B型主动脉夹层腔内隔绝术的应用

Anterograde and retrograde technique in thoracic endovascular aortic repair for complicated type B aortic dissection

目的探讨正逆向技术在复杂B型主动脉夹层腔内隔绝术的应用。方法从2009年2月至2014年1月收治的102例复杂B型主动脉夹层患者中89例常规逆向导丝技术成功行经皮主动脉腔内隔绝置入术为对照组;13例常规逆向导丝技术失败而采用正逆向导丝技术经皮主动脉腔内隔绝置入术为治疗组。比较两组术前、术后3个月主动脉最大假腔及最小真腔直径、院内死亡、平均住院时间、手术曝光时间。结果所有患者术后即时造影示胸主动脉近端破口已被完整覆盖,无内漏、截瘫等严重并发症发生。治疗组手术即刻成功率100%;对照组手术成功率为93.5%;两组术前最大假腔直径比较无统计学意义(P=0.23);两组术前最小真腔直径比较差别具有统计学意义(P=0.028)。随访3个月无心血管重要事件发生,复查CTA主动脉假腔无明显扩大,最大假腔直径无明显差别(P=0.33)。结论对于不能通过逆向导丝技术完成的病变,采用正逆向技术可使手术成功率明显提高;是一种可行和安全的,并有良好的近期疗效的手术方法。

Objective To investigate the feasibility and safety of anterograde and retrograde technique in thoracic endovascu- lar aortic repair （TEVAR） in the treatment of complicated type B aortic dissection. Methods From February 2009 to January 2014, 102 Cases of complex type B aortic dissection patients admitted to our hospital, 89 cases who received TEVAR by routine transcutaneous retrograde wire technique as control group. 13 cases who received TEVAR by anterograde and retrograde technique following failure of routine transcutaneous retrograde wire technique as treatment group. Compare the aortic maximum false lumen and minimum true lumen diameter in two groups of preoperative and postoperative 3 months,in-hospital mortalities,time of X ray exposure and length of stay. Results Angiography after the operation showed that the proximal thoracic aorta rupture were sealed completely, and the viscera arterial blood supply was restored mainly via the true lumen in all patients. The instant success rate of operati0nswas 100% in treatment group,compared with the control group was 93.5%. no case was occurred serious complications such as endoleak and paraplegia.Two groups of preoperative false lumen diameter are no statistical significance （P=0.23）,Com- pared two groups of preoperative minimum true lumen diameter have statistical significance （P=0.028）. Follow-up 3 months after operation revealed no major cardiovascular events happened, review the CTA aortic false lumen has no obvious expansion, and the postoperative maximum false lumen, diameter was no evident difference between two groups（P=0.33）. Conclusion Anterograde and retrograde technique significantly increases the success rate of procedure in patients who failed in retrograde wire technique. It is feasible and safe to perform anterograde and retrograde technique in complicated type B dissection patients with adequate short- term outcomE.