主动脉夹层累及腹腔分支二期腔内治疗的中期研究

A mid-term study on the secondary endovascular treatment of aortic dissection involving visceral branches of abdominal aorta

目的评价主动脉夹层(aortic dissectio,AD)胸主动脉一期手术后,夹层累及腹腔动脉分支的二期腔内治疗方法和中期疗效。方法选择2020年11月至2021年8月,因主动脉夹层行一期手术后,存在夹层累及腹腔分支,导致假腔逐步增大和脏器缺血的患者行二期腔内治疗,研究共回顾性收集18例患者资料,年龄29~60岁,平均(40.05±3.45)岁。一期二期手术间隔14天~8个月;二期腔内治疗手段包括胸、腹主动脉以及腹腔分支覆膜支架隔绝成形术,假腔弹簧圈栓塞等。术中DSA观察疗效;术后6个月到15个月随访对比CT表现,随访截止时间2022年10月。结果所有患者均顺利完成腔内治疗,18例患者共植入胸、腹主动脉覆膜支架19枚,支架直径20~28 mm,长度80 mm;植入腹腔动脉分支覆膜支架20枚,其中右肾动脉10枚,左肾动脉7枚,腹腔干2枚,肠系膜上动脉1枚;假腔弹簧圈栓塞5例。随访评估18例患者真假腔重构和脏器供血情况:优良40%;好转50%;改善10%。腹腔动脉分支覆膜支架通畅率100%。结论主动脉夹层一期手术后夹层累及腹腔动脉分支的二期腔内处理安全有效,部分患者可获得优良疗效,有效促使真假腔重构朝有利方向发展。

Objective To evaluate the secondary endoluminal treatment and medium-term efficacy of dissection involving the branch of the abdominal aorta after aortic repair.Methods From November 2020 to August 2021,patients with dissection involving abdominal visceral branches resulting in the prosthetic cavity gradually enlarging and organ ischemia after primary endovascular repair were selected for secondary endovascular treatment,and a total of 18 patients were retrospectively collected,with an average age of 40.05±3.45 years old between 29 and 60 years old.The interval between the primary and second stages of operation ranges from 14 days to 8 months.The second stage of intraluminal treatment includes:chest,abdominal aorta,and abdominal branch covering stent implantation,pseudo-cavity coil embolism,etc.Imaging data were collected from 6 to 15 months after operation,and the DSA was reviewed immediately during operation,and the CT performance of patients was followed up from 6 to 15 months after operation.Results All patients successfully completed endoluminal treatment.A total of 19 thoracic and abdominal aortic mulching stents were implanted in 18 patients,with a diameter of 20~28 mm and a length of 80 mm,and 20 covered stents were implanted in the branch of the abdominal artery,including 10 covered stents of right renal artery,7 of left renal artery,2 of peritoneal trunks,1 of upper mesenteric artery,and 5 cases of pseudo-cavity coil embolism.Follow-up evaluation of true and false cavity reconstruction and organ blood supply in 18 cases,including excellent(40%),better(50%),improvement(10%).The patency rate of the covered stent of the abdominal visceral branches was 100%.Conclusions The secondary endovascular treatment of aortic dissection involving the branch of the abdominal artery after primary endovascular repair is safe and effective,and some patients can achieve clinical cure,which effectively promotes the development of true and false cavity reconstruction in a favorable direction.