分支支架治疗锚定区不足Stanford B型主动脉夹层临床研究

Clinical research of branched stent-graft in the treatment of Stanford B aortic dissection with insufficient landing zone

目的探讨分支支架治疗锚定区不足15mm的Stanford B型主动脉夹层的临床疗效并进行经验总结。方法回顾性分析福建省立医院自2017年9月至2019年9月期间,应用Castor分支支架行胸主动脉腔内修复手术治疗的16例患者的临床数据,患者均为近端有效锚定区小于15mm的急性Stanford B型主动脉夹层。术前经胸腹主动脉计算机断层造影(computed tomography angiography,CTA)明确诊断,术中通过数字剪影血管造影(digital subtraction angiography,DSA)评估血管及支架情况,术后3个月复查胸腹主动脉CTA。结果 16例患者手术成功,成功率100%;无死亡病例;无脑梗死、近端内漏、截瘫、主动脉破裂等严重并发症;术中支架释放后造影发现2例分支支架近端狭窄,予球囊扩张后狭窄消失。16例患者完成随访,平均随访(12±5.6)个月;随访中无死亡;无支架移位、分支支架狭窄、夹层逆撕;术后主动脉峡部真腔直径(30.2±3.2)mm,较术前明显扩大[(17.8±4.7)mm(t=7.923,P<0.05)];术后主动脉峡部假腔直径(11.9±3.0)mm,较术前明显缩小[(24.8±4.3)mm(t=13.584,P<0.05)];术后主动脉穿膈处真腔直径(22.7±4.6)mm,较术前明显扩大[(13.9±4.1)mm(t=9.871,P<0.05)];术后主动穿膈处假腔直径(14.3±6.3)mm,较术前明显缩小[(22.3±5.6)mm(t=8.365,P<0.05)]。结论应用Castor分支支架行胸主动脉腔内修复手术治疗锚定区不足Stanford B型主动脉夹层,操作时间短、容易掌握、近期疗效良好,能有效封闭夹层破口,保持左锁骨下动脉通畅,远期疗效有待进一步随访。

Objective To explore the clinical efficacy of Castor branch stent in treating Stanford type B aortic dissection with less than 15mm anchoring area and share the experience.Methods Clinical data of 16 cases of acute Stanford type B aortic dissection with proximal effective anchoring area less than 15mm were retrospectively analyzed from September 2017 to September 2019.The diagnosis was confirmed by preoperative computed tomography angiography(CTA),the aortic and stents were evaluated by digital subtraction angiography(DSA)during operation,and CTA of thoracic and abdominal aorta was reexamined 3 months after operation.Results Sixteen patients were operated successfully with the success rate of 100%.There were no deaths and severe complications such as cerebral infarction,proximal internal leakage,paraplegia and aortic rupture.The proximal stenosis of branch stent was found in 2 cases by angiography after stent release,and the stenosis disappeared after balloon dilation. Sixteen patients were followed up for an average of (12±5.6)months. There were no any deaths, stent displacement, branch stent stenosis and reverse tearingduring follow-up. The true lumen diameter of aortic isthmus was larger than that before operation[(30.2±3.2)mm v.s. (17.8±4.7)mm, (t=7.923, P<0.05)]. The false lumen diameter of aortic isthmuswas smaller than that before operation [(11.9±3.0) mm v.s. (24.8±4.3) mm, (t=13.584, P<0.05)].The true lumen diameter of aortic diaphragm was larger than that before operation [(22.7±4.6) mmv.s. (13.9±4.1) mm, (t=9.871, P<0.05)]. The diameter of the false lumen of aortic diaphragm wassignificant smaller than that before operation [(14.3±6.3)mm v.s. (22.3±5.6) mm, (t=8.365, P<0.05)].Conclusion The application of Castor branch stent in thoracic endovascular aortic repair for thetreatment of Stanford type B aortic dissection with insufficient anchoring area is less time consuming,easy to master, and effcient in a short-term. The dissection rupture is effectively closed, and the leftsubclavicular artery is kept unobstructed.