血管腔内处理Stanford B型主动脉夹层内脏动脉区裂口策略

Endovascular repair strategy for Stanford type B aortic dissection involving visceral branches

胸主动脉腔内修复术(TEVAR)是目前Stanford B型主动脉夹层常规治疗方法。治疗中通常只隔绝原发裂口,即所谓近端裂口,而对远端裂口较少实施干预。随着对夹层术后主动脉重塑进一步深入研究,研究者们发现术后25%~40%患者出现远端扩张,需再干预处理。其中腹主动脉内脏分支区裂口处理涉及重要脏器血供,治疗上存在一定特殊性。本文结合国内外研究进展,就腹主动脉内脏分支区夹层裂口常用处理方法作一综述。

At present, thoracic endovascular aortic repair（TEVAR） is the routine treatment for Stanford type B aortic dissection. Usually, during the interventional treatment only the primary entry tear, i.e.so-called proximal entry tear, is to be isolated with a stent-graft, while less intervention is adopted for the distal entry tear. With the deepening of research concerning aortic remodeling after TEVAR, the researchers have found that 25%-50% of patients will develop aneurysmal dilation at the distal end of dissected aorta,which needs to be treated again. Among them, the treatment of entry tear at visceral branch area of the abdominal aorta has a certain degree of difficulty and technical particularity as the interventional management may affect the blood supply of vital organs. Referring to the research progress at home and abroad, this article aims to make a review about the common therapeutic methods for the entry tear at visceral branch area of the abdominal aorta.