B型主动脉夹层血管修复术后并发症及影像学远期随访

Long-term follow-up of complications and images of endovascular repair for Stanford type B aortic dissection

目的总结Stanford B型主动脉夹层(aortic dissection Stanford B,TB-AD)腔内修复术的治疗经验及远期随访结果,并重点追踪未被带膜支架覆盖的夹层部分变化情况。方法对2009年1月至2014年1月诊断为TB-AD,在江门市中心医院进行主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)的、能够进行全程随访的52例患者的临床资料进行回顾性分析。结果 52例患者TEVAR手术均获成功,成功率100%。左颈总动脉-左锁骨下动脉转流术1例,带膜支架覆盖腹主动脉至肠系膜动脉开口2例,其余患者均在左锁骨动脉开口以远植入带膜支架。随访(39.8±18.4)个月,术后内漏3例(5.7%),感染1例(1.9%),死亡1例(1.9%)。主支气管分叉水平的手术前、后主动脉真腔与假腔计算机断层扫描平均值差分别为107.0±68.0和227.5±100.2,管腔直径差为(-1.4±1.1)cm和(1.2±0.93)cm。未被带膜支架覆盖的夹层部分仍存在真假腔43例(82.7%)。结论 TB-AD腔内修复术远期随访结果满意,术前夹层破口未闭的患者中未被带膜支架覆盖的夹层部分仍存在真假腔,但风险低。

Objectives To summarize the experience and analyze the long term follow-up outcome of endovascular repair for Stanford type B aortic dissection（TB-AD）,especially the change of sections which were not covered by coated metallic stents. Methods Data of 52 consecutive TB-AD patients treated by thoracic endovascular aortic repair （TEVAR） in Jiangmen Central Hospital from January 2009 to January 2014 were analyzed retrospectively. Results Technical success was achieved in a11 cases. Left common carotid to left subclavian arterial bypass in 1 cases,and the abdominal aorta ,which was superior mesenteric artery covered by coated metallic stents in 2 cases. The other patients were implanted covered stent through left subclavian artery opening. During the follow-up of（39.8±18.4）months, postoperative endoleak,infection,mortality were observed in 3 cases（5.7%）,1 case（1.9%）and 1 case（1.9%）. Change of computed tomography（CT）density value in true lumen and false lumen was 107.0±68.0 and 227.5±100.2, and the difference of lumen diameter was（-1.4±1.1）cm and（1.2±0.93）cm,respectively. There were still 43 cases （82.7%）have true and false lumen in the part which was not covered by the coated metallic stents. Conclusions Long term outcome of endovascular repair for TB-AD are satisfactory. The part of aortic dissection without stent coverage still exist the true and false lumen if the lacuna of aortic dissection not closed before operation ,but its risk is low.