摘要
目的评估血管内超声(intravascular ultrasound,IVUS)在复杂Stanford B型主动脉夹层(aortic dissection,AD)胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)的应用价值。方法回顾性分析2017年10月~2018年12月20例复杂Stanford B型AD行IVUS辅助TEVAR的资料。术中应用IVUS评估锚定区管壁情况,判断真假腔,远端再破口数量,腹腔分支动脉受累数量,支架植入后即刻效果,并与数字减影血管造影(digital subtraction angiography,DSA)结果进行对比。结果DSA不能显示管壁钙化及壁内血肿,IVUS显示20例中6例管壁钙化,4例壁内血肿,与术前CT血管造影(CTA)一致。IVUS可以明确判别20例真假腔,其中5例真假腔DSA无法判别。在17例中IVUS较DSA多显示32个远端再破口,在6例中多显示11条受累内脏动脉。术后即刻IVUS显示支架近端锚定区前小的新发血肿1例,贴壁不良、少量I型内漏1例,DSA无法显示。结论IVUS在TEVAR术中较DSA可以帮助术者获得更多、更准确的直观动态信息,适宜复杂TEVAR术中使用。
Objective To evaluate the value of intravascular ultrasound(IVUS)in the endovascular aortic repair(TEVAR)of complicated Stanford B-type aortic dissection(AD).Methods From October 2017 to December 2018,a retrospective analysis was made on data of 20 patients with complicated Stanford B-type AD who underwent IVUS assisted TEVAR.During surgery,IVUS was applicated to assess the condition of the landing zone wall,the true and false lumens,the number of distal reentries,branch vessels in abdominal aorta involved,and the immediate effect after stent implantation,as well as compared with DSA results.ResultsThe DSA could not identify calcification or intramural hematoma.In the 20 cases,the IVUS identified 6 cases with calcification and 4 cases with intramural hematoma,consistent with preoperative CTA.The IVUS could clearly distinguish true and false lumen in all the 20 cases,and the DSA distinguished in 15 cases.The IVUS showed 32 more distal reentries than DSA in 17 cases,and 11 more involved visceral arteries than DSA in 6 cases.Immediately after the operation,the IVUS showed 1 case of small new hematoma in front of the proximal landing zone of the stent and 1 case of poor adhesion and small typeⅠendoleak,while there was no positive findings in DSA.Conclusion Compared with DSA in TEVAR,IVUS can help the surgeon obtain more accurate visual dynamic information,which is suitable for complicated TEVAR.
作者
刘光锐
郭曦
韩晓峰
李铁铮
马晓海
Liu Guangrui;Guo Xi;Han Xiaofeng(Interventional Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)
出处
《中国微创外科杂志》
CSCD
北大核心
2021年第3期235-238,共4页
Chinese Journal of Minimally Invasive Surgery
基金
国家重点研发计划项目(2017YFC1308000)。
关键词
血管内超声
胸主动脉腔内修复术
主动脉夹层
Intravascular ultrasound
Thoracic endovascular aortic repair
Aortic dissection