应用支架型人工血管治疗主动脉夹层45例报告

Endovascular treatment of aortic dissection using stent-graft:report of 45 cases

目的 探讨支架型人工血管治疗主动脉夹层的临床效果。方法 2 0 0 1年 3月至 2 0 0 3年 9月间 ,应用支架型人工血管治疗Ⅲ型夹层 44例和Ⅰ型主动脉夹层 1例。 45例主动脉夹层共应用 56个支架型人工血管行近侧内膜破口封堵 ,1例同时行远侧内膜破口手术关闭 ,1例远侧破口以分叉的支架型人工血管封闭。结果 所有病人均获得技术成功。围手术期死亡 2例 ,1例术后 12h后死于脑出血 ,1例术后 10d死于假腔破裂 ;1例手术后半年死于细菌性心内膜炎。结论 支架型人工血管行Ⅲ型主动脉夹层和破口在降主动脉的Ⅰ型主动脉夹层破口封堵术较传统手术安全 。

Objective To summarize our preliminary experience of endova scular t reatment of aortic dissection with stent graft. Methods F orty four case s with type Ⅲ aortic dissection and one case with type Ⅰ aortic dissection were treated by using stent graft from March 2001 to September 2 00 3. Fifty six pieces of thoracic stent graft were applied to the seal of proxima l intimal rupture in 45 cases (in 11 cases, each case used two stent grafts). Th e distal intimal rupture was sealed through operation,and a bifurcate stent graf t in 1 case, respectively. Results The technical success was achieved in all cases . Two peri operative deaths occurred due to rupture of false lumen on the 10th d ay a fter procedure and cerebral bleeding the 12th hour following procedure in 1 cas e,respectively. One case died of infectious endocarditis half a year after the p roce dure. Conclusion Compared with traditional operation, the stent gr aft technique is safe for type Ⅲ aortic dissection and type Ⅰ aortic dissection with intimal rupture in descending aorta. However, the long term investig ation is required.