急性Stanford B型主动脉夹层行腔内隔绝术后的主动脉重塑

Aortic remodeling after thoracic endovascular aortic repair with stent graft in acute type Stanford B aortic dissection

目的 探讨急性Stanford B型主动脉夹层行胸主动脉腔内修复（thoracic endovascular aor-tic repair,TEVAR）术后的主动脉重塑过程及形态学变化.方法 回顾性分析2015年9月至2016年8月诊断为急性Stanford B型主动脉夹层且行TEVAR手术的51例患者临床资料,利用CTA图像测量原发破口水平、气管分叉水平、腹腔干动脉水平及左肾动脉下缘水平真腔、假腔直径,并计算术后真、假腔直径变化率.结果 近端破口水平,术后真腔扩大及假腔缩小在术后1个月和1年最为明显（P〈0.05）,在术后3个月及术后6个月较为稳定,真、假腔均无明显变化（P〉0.05）.气管分叉水平,真腔持续扩大而假腔持续缩小.在腹腔干动脉及左肾动脉下缘水平,真腔直径呈缓慢增大趋势,而假腔直径变化不明显.结论 急性Stanford B型主动脉夹层行TEVAR术后,胸主动脉段重塑较佳,真腔得到明显恢复,假腔明显减小,假腔血栓形成并吸收率高,而对于支架血管未能覆盖的降主动脉远端重塑作用则较差.

Objective To explore the aortic remodeling after thoracic endovascular aortic repair for acute type stanford B aortic dissection. Methods Retrospective analysis the clinical data of 51 patients who diagnosed with acute type B aortic dis-section and received TEVAR between September 2015 and August 2016. The maximal diameters of false and true lumen were measured directly at the level of primary tear entry, the level of the bronchial bifurcation,and the level of the celiac trunk and the the lower edge of left renal artery,changes in diameter were evaluated between the preoperative and postoperative CT scan. Results The marked change in the true lumen dilatation and false lumen regression trend at the level of primary tear entry after thoracic endovascular repair（1 month vs 1 year, P〈0. 05）, while the changes of its diameter above level were not obvious af-ter thoracic endovascular repair（3 months vs 6 months, P〉0. 05）. the true lumen dilatation and false lumen regression trend at the level of the bronchial bifurcation along with time. The true lumen dilatation is a process of slow change at the level of the celiac trunk and the lower edge of left renal artery after TEVAR, and the false lumen changed not obviously. Conclusion En-dografting is effective for acute type B aortic dissection which can promote positive descending aortic remodeling changes,but it has no significant effect on abdominal aortic remodeling.