血管内超声显像在主动脉夹层动脉瘤人工血管内支架术中的应用

Application of intravascular ultrasound imaging in Stent-grafting of aortic dissecting aneurysm

目的 评价血管内超声 (IVUS)显像在主动脉夹层动脉瘤人工血管内支架术中的作用。方法 选择 2 0 0 1年4月～ 2 0 0 2年 12月在我院血管外科行人工血管内支架术的降主动脉夹层动脉瘤 7例 ,评价IVUS在支架尺寸选择、操作定位和疗效观察等方面的作用。结果 在夹层动脉瘤人工血管内支架术中 ,通过IVUS测量近端真腔的最大直径可验证支架尺寸的选择 ,通过测量破口距左锁骨下动脉开口的距离可确定支架的释放部位 ,结合IVUS的套圈方法可确保支架在真腔内释放。支架释放后 ,可通过IVUS观察支架与真腔壁的贴附状况 ,及时发现Ⅰ型内漏。结论 在降主动脉夹层动脉瘤人工血管内支架术中 ,IVUS可验证支架尺寸的选择 。

Objective To assess the role of intravascular ultrasound (IVUS) imaging in the stent grafting of dissecting aortic aneurysm. Methods Between April 2001 and December 2002, 7 patients with dissecting aneurysm of the descending thoracic aorta received stent grafting under the guidance of IVUS. The role of IVUS was assessed in the size of the stent graft'selection, the deployment site and observation of the therapeutic effect. Results In the stent grafting of dissecting aneurysm of the descending thoracic aorta, stent graft size could be determined by the maximum diameter of the proximal true lumen measured by IVUS. The deployment location could be demonstrated by measuring the distance between the entry site and the orifice of the left subclavian artery during IVUS. The IVUS monitored snare technique could ensure the stent graft to be deployed in the true lumen. With the aid of IVUS, type I endoleak could be detected in time by observing the anchoring of the stent graft to the true lumen. Conclusion In the stent grafting of dissecting aneurysm of the descending thoracic aorta, IVUS can provide the guidance for confirmation of the stent graft size, the deployment location and evaluation of the therapeutic effect.