腔内隔绝术治疗胸主动脉夹层动脉瘤

Endovascular graft exclusion of aortic dissection

目的 :探讨腔内隔绝术治疗胸主动脉夹层动脉瘤的指征、方法、疗效。 方法 :1例高龄主动脉夹层动脉瘤患者 (DeBakeyⅢB型 )在主动脉造影 (DSA)动态监视下 ,用 1 30mm× 4 4mm涤纶人工血管内支撑复合体经左髂外动脉导入 ,对胸主动脉夹层进行腔内隔绝治疗。 结果 :术后即刻DSA示原主动脉夹层内膜破口封闭 ,夹层假腔不再显影。患者术后次日进食 ,1周出院。术后 1周及 1个月多普勒和CT血管造影 (CTA)复查显示 :移植物通畅 ,内径36mm ,支架无扭曲及移位 ,无内漏发生 ,假腔内充满血栓。 结论 :DeBakeyⅢ型主动脉夹层动脉瘤患者适合于腔内隔绝术治疗。该方法具有微创、便捷和疗效确实的优点 ,临床应用前景良好。

Objective:To explore the operative indications, methods, curative effects and clinical prospect of Endovascular Graft Exclusion (EVGE) for descending thoracic aortic dissection (TAD). Methods:Under dynamic supervision of DSA, an EVGE with a stent graft complex of 130 44 mm was performed successfully on a 75 year old man with an aortic dissection (DeBakey ⅢB type). Results:Following the operation, DSA revealed that the intimal tear of the dissection was excluded by the endoluminal stent graft complex and the false lumen disappeared. The postoperative one week and one month, Duplex scan and CTA revealed that the stent graft complex was patent and had an inner diameter of 36 mm, without any migration and torsion. The false lumen of dissection was full of thrombi. The patient was discharged in a week. One month postoperative follow up showed that the patient was recovered to his usual normality. Conclusion:The indications for EVGE are DeBakey ⅢB type aortic dissections with the intimal tear, EVGE is a minus invasive method with a firmly curative effects, its clinical prospect will be very bright.