Stanford B型主动脉夹层腔内修复术中支架种类及尺寸的选择策略

Thoracic stent graft sizing for endovascular repair in Stanford type B aortic dissection

Stanford B型主动脉夹层腔内治疗使用的是胸主动脉覆膜支架系统，该系统由覆膜支架和输送系统组成，在支架构型、输送系统及释放方式上有所不同。Stanford B型主动脉夹层腔内治疗原理与主动脉瘤有区别，因此在支架选择上亦有区别。在完成术前影像评估和测量的基础上，建议支架近端尺寸的放大率为0-5％，长度为160-200mm，支架远端越过降主动脉弯曲处，以达到顺应降主动脉血流、支架远端尺寸的放大率为0的目的。熟悉支架特性，了解支架可能带来的副作用，结合实际情况，掌握以上原则，可有效减少支架近端逆撕和支架远端内膜破裂的发生，降低术后并发症发生率和病死率。

Endovascular treatment for Stanford type B aortic dissection uses thoracic aortic stent- graft system, which consists of covered stent and delivery system. The system is different in the configuration of the stent, the delivery system and the mode of release. The principle of endovascular treatment for Stanford type B aortic dissection is different from aortic aneurysm, so there are differences in stent selection. On the basis of preoperative assessment and measurement, it is suggested that the proximal diameter oversize of the stent is 0 to 5%, at 160 to 200 millimeters in length. The distal end of the stent should pass through the bend of the descending aorta to accommodate the descending aorta blood flow, and the oversize is O. The postoperative complications and mortality including reverse dissection of proximal part and intima rupture of distal part induced by the stent will be effectively reduced with familiarity with the characteristics of stent- graft, understanding of the possible side effects of stent-graft, combining with the actual conditions and mastering the above principles.