Stanford A型主动脉夹层的腔内治疗策略及效果评估

Endovascular repair for the treatment of Stanford Type A aortic dissection

目的回顾性分析本中心应用腔内技术（thoracic endovascular repair，TEVAR）治疗StanfordA型主动脉夹层的治疗策略及疗效。方法2010年1月至2016年12月因A型主动脉夹层在本中心接受TEVAR治疗的68例患者中男51例，女17例，平均年龄（58±9）岁。结果所有病例支架主体均成功释放。共置入主体支架56枚，CUFF18枚。通过杂交技术、烟囱技术重建弓上分支动脉48支，其中包括头臂动脉6支，左颈总动脉18支，左锁骨下动脉24支。围手术期死亡4例，内漏13例。脑梗死患者2例。出院患者随访6—112个月，随访期间1例术后6个月因多器官功能衰竭死亡，新发内漏2例，左上肢缺血1例，CTA提示支架均无明显移位并保持通畅，主动脉重塑良好。结论经过谨慎选择的A型主动脉夹层患者的优化腔内治疗可以使患者获益。

Objective To evaluate thoracic endovascular repair （TEAVR） techniques for the treatment of Stanford type A aortic dissection. Methods From Jan 2010 to Dee 2016, 68 cases （ male 51, female 17, age 58 ± 9 years） of Stanford type A aortic dissection were treated by endovascular stent grafting. Results Aortic stents were delivered and deployed successfully in all target arteries. 48 important aortic arch arteries were reconstructed （brachiocephalic trunk 6, left carotid commond artery 18, left subclavian artery 24）. 30-day mortality rate was 5.9% （4/68）. Endoleak developed in 13 cases and new stroke in 2 cases. Average follow-up time was 6 - 112 months. One death occurred after 6-months postoperatively for multiple organ failure. 2 cases were new endoleak and 1 case was left upper limb ischemia- Up to the most recent review or death, the false lumen remained thrombosed in all cases. Conclusions Optimized endovascular stent-graft treatment is effective method to treat Stanford type A aortic dissection.