真腔覆膜支架点状植入联合假腔内栓塞技术治疗腔内修复术后主动脉夹层动脉瘤

Spot stenting combined with false lumen endovascular occlusive repair in treatment of postoperative aortic dissecting aneurysm

目的 :回顾性评价真腔覆膜支架点状植入联合假腔内栓塞技术(spot stenting combined with false lumen endovascular occlusive repair,SS-FLEVOR)治疗腔内修复术后主动脉夹层动脉瘤的中期结果 。方法 :收集2016年10月至2020年10月间采用SS-FLEVOR治疗胸主动脉腔内修复(thoracic endovascular aortic repair, TEVAR)术后主动脉夹层动脉瘤病人围术期及随访资料。分析病人手术前后胸主动脉、腹主动脉真腔最大径、假腔血栓化及内脏动脉分支支架通畅情况。结果:TEVAR术后远端瘤样扩张病人17例,平均年龄(54.5±14.5)岁,女3例。SS-FLEVOR手术均成功,平均手术时间(151.4±37.9) min。平均随访(24.9±20.7)个月。随访期间内脏动脉分支支架均通畅。胸主动脉和腹主动脉假腔均血栓化10例,胸主动脉假腔血栓化3例,胸主动脉和腹主动脉假腔仍存在部分血流4例。因假腔内血流逐渐减少且瘤体未增大,未予以二次干预。胸主动脉和腹主动脉真腔最大径均较术前增大。术前胸主动脉真腔最大径(1.7±0.7) cm,术后(2.1±0.6) cm(P=0.001)。术前腹主动脉真腔最大径(1.1±0.4) cm,术后(1.4±0.6) cm(P=0.001)。1例术后6个月CT复查发现,腹主动脉真腔局部因假腔内支架压迫较术前缩小(1.3 cm比1.7 cm)。所有病人随访期间未发生假腔支架移位与截瘫,以及感染、内脏动脉分支闭塞等并发症。结论:SS-FLEVOR技术相对安全有效,可操作性强,对特定病例可取得较好疗效。

Objective To retrospectively evaluate the mid-term outcome of spot stenting combined with false lumen endovascular occlusive repair(SS-FLEVOR) in the treatment of postoperative aortic dissection aneurysm. Methods Both perioperative and follow-up data of the patients with aortic dissection aneurysm after thoracic endovascular aortic repair(TEVAR) who underwent SS-FLEVOR from October 2016 to October 2020 were collected and analyzed. The preoperative and postoperative largest diameters of both thoracic aortic true lumen and abdominal aortic true lumen were analyzed combined with the thrombus in false lumen and stents patency of visceral arteries. Results A total of 17 cases were enrolled with an average age of(54.5±14.5) years and 3 cases female. SS-FLEVOR was all successful. Mean operative time was(151.4±37.9) min with follow-up time of(24.9±20.7) months. During the follow-up period, the stents in visceral arteries were all patent. Thrombus was formed in thoracoabdominal aortic false lumen 10 cases and in thoracic false lumen 3 cases. Partial blood flow was found 4 cases in thoracoabdominal aortic false lumen. The sac size did not increase due to decreasing in blood flow of the false lumen gradually and secondary intervention was not needed. The true lumens diameter increased compared with those of preoperative for thoracic aorta [(2.1±0.6) cm vs.(1.7±0.7) cm, P=0.001] and for abdominal aorta [(1.4±0.6) cm vs.(1.1±0.4) cm, P=0.001]. The diameter of true lumen decreased in 1 case after six months post operation(1.3 cm vs. 1.7 cm) due to the compression caused by the stent-graft in false lumen. There was no stent displacement, paraplegia, infection, visceral artery stent occlusion and other complications occured during the period of follow-up. Conclusions SS-FLEVOR might be relatively safe, effective and feasible with satisfied results for specific cases.