血管内超声在胸主动脉腔内修复术中的应用

Application of intravascular ultrasound in endovascular repair of thoracic aorta

目的应用血管内超声(intravascular ultrasound,IVUS)辅助胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR),治疗Stanford B型主动脉夹层(aortic dissection,AD)、壁间血肿(intramural hematoma,IMH)和主动脉穿通性溃疡(penetrating aortic ulcer,PAU),取得术前、术后即刻精准解剖信息。方法分析2015年10月至12月11例IVUS辅助的TEVAR术,患者均为男性,年龄为(65.0±3.6)岁。术前观察AD管腔受累准确范围、锚钉区、真/假腔、破口、头颈部分支和腹腔分支;术后观察支架隔绝效果、贴壁情况和分支血管供血变化等。结果在11例患者中,1例(9.1%)IMH伴PAU,10例Stanford B型AD(其中7例腹腔分支受累63.6%)。手术成功率为100%,全部进行术中观测,取得精准数据。结论 IVUS操作简单快捷,可以帮助术者获得即刻术中直观精准信息,值得于TEVAR术中推广应用。

Objective To use intravascular ultrasound(IVUS) to assist thoracic endovascular aortic repair(TEVAR) for Stanford type B aortic dissection(AD),intramural hematoma(IMH),and penetrating aortic ulcer(PAU),which could obtain accurate anatomical information of thoracic aortic wall in pre-and post-operative.Methods From October to December in 2015,11 patients,all males(65.0±3.6),suffered from Stanford type B AD were utilized IVUS during TEVAR to observe the exact range of false lumen of AD,the proximal landing zone,true/ false lumen,intimal tear,branch vessels in preoperative,as well to evaluate the sealing effect of stent grafts,sticking with aortic wall,and branched blood supply changes in postoperative.Results For all 11 patients,in which one with PAU accompanied with IMH,others with Stanford type B AD(7 patients involving in visceral blood supply malformation,63.6%),there were no intraoperative death and technical success rate was 100%.All patients were detected by using IVUS to obtain accurate data during TEVAR.Conclusion The operation of IVUS is convenient and easy to control during TEVAR,which can acquire precise aortic pathologies,as well worthy to market this technique in intraoperative.