Stanford B型主动脉壁间血肿壁间动脉瘤近中期疗效分析

Analysis of early and midterm treatment effect for intramural aneurysms of Stanford type B aortic intramural hematoma

目的总结主动脉壁间动脉瘤的临床特点及近中期随访结果。方法回顾2013年9月至2015年9月本科收治的16例经全主动脉CT血管造影(CTA)检查确诊为Stanford B型主动脉壁间血肿合并壁间动脉瘤患者的临床资料,共41处壁间动脉瘤,分别在发病时和发病后1、3、6个月和1年复查主动脉CTA,观察壁间动脉瘤的变化情况和壁间血肿的吸收情况。结果 1例患者在随访3个月时壁间动脉瘤扩大,2例合并主动脉穿透性溃疡患者在随访期间壁间血肿无吸收,行胸主动脉腔内修复术治疗后1周壁间动脉瘤血栓化消失。随访3个月时,14处壁间动脉瘤消失或血栓化,7例患者壁间血肿吸收;6个月时,32处壁间动脉瘤消失或血栓化,13例壁间血肿吸收;1年时,38处壁间动脉瘤消失,3处部分血栓化,14例壁间血肿完全吸收,2例血肿大部分吸收。结论主动脉壁间动脉瘤大部分随着血肿的吸收能自愈,但临床需要与穿透性主动脉溃疡相鉴别。

Objective To summarize the clinical characteristics and analyze the evolution of early and midterm follow-ups of intramural aneurysms in aortic intramural hematoma. Methods Clinical data of 16 patients with 41 intramural aneurysms of Stanford type B aortic intramural hematoma, confirmed by CTA of the whole aorta from September 2013 to September 2015 were retrospectively analyzed. All of them received conservative therapy, and CT angiography of the aorta was performed at onset and 1,3,6, and 12 months post-onset to observe the changes of the intramural aneurysms and the absorption of the aortic intramural hematoma. Results One intramural aneurysm dilated in 1 patient at 3 months, 2 aortic intramural hematoma with penetrating aortic ulcer were not absorbed and the pleural fluid on the left side increased, and thoracic endovascular aortic repair treatment was performed on these 3 patients; 14 intramural aneurysms disappeared or thrombosed, and the aortic intramural hematoma was absorbed in 7 patients after 3 months; 32 intramural aneurysms disappeared or thrombosed, and 13 patients^ aortic intramural hematoma were absorbed after 6 months; after 1 year a total of 38 intramural aneurysms disappeared, while the sizes reduced significantly in the other 3 cases, the aortic intramural hematoma were absorbed completely in 14 patients and were absorbed incompletely in 2 patients. Conclusion Most intramural aneurysms spontaneously thrombose concomitant with absorption of intramural hematoma, however, it is important to distinguish the intramural aneurysms from the penetrating aortic ulcer.