胸主动脉夹层动脉瘤腔内隔绝术中Ⅱ型内漏的影像学识别和处理

Identification of image and management of type Ⅱ endoleaks in endovascular exclusion for thoracic aortic dissections

目的 探讨胸主动脉夹层动脉瘤腔内隔绝术中Ⅱ型内漏的评估、处理方法。方法 在1998年4月至2001年12月实施的116例胸主动脉夹层动脉瘤腔内隔绝术中通过造影发现Ⅱ型内漏共7例。应用鱼精蛋白中和肝素作促凝治疗。结果 促凝治疗后4例内漏消失;3例带漏返回。术后经密切观察随访,2例内漏自行闭合,另1例也未发现动脉夹层腔明显扩大。结论促凝是术中Ⅱ型内漏简单而有效的治疗方式。对术后持续存在的Ⅱ型内漏的处理方法还有待进一步的探索。

Objective To assess the principles of evaluation and management of type Ⅱ endoleaks in the procedure of endovascular exclusion ( EVE) for thoracic aortic dissections (TAD) . Methods In a consecutive series of patients underwent EVE for TAD, type Ⅱ endoleaks were detected by means of DSA intraoperatively in 7 patients among 116 cases with TAD between April, 1998 and December, 2001. Coagulation - promotion with prostamine was attempted to use to seal the leakages. Results The leakages disappeared in 4 cases after treatment of coagulation - promotion . In the remaining 3 patients, the endoleaks of 2 cases occluded spontaneously and the other case was kept under observation without a significant increase of the aneurysm during the follow - up period. Conclusion Coagulation - promotion is simple and effective for treatment of type Ⅱ endoleaks intraoperatively. However, management for persist typeⅡ endoleaks postoperatively will be required to search furtherly.