腔内修复术治疗破口位于降主动脉合并逆撕性壁间血肿的主动脉夹层

Thoracic endovascular aortic repair of the aortic dissection with intimal tears in the descending aorta and retrograde intramural hematoma

目的：分析破口位于降主动脉合并逆撕性壁间血肿（RIMH）的临床特征以及总结胸主动脉腔内修复术（TEVAR）治疗该病的临床经验。方法回顾分析2011年1月至2014年5月广州军区武汉总医院心胸外科收治的36例行CT血管造影检查确诊为破口位于降主动脉合并RIMH的主动脉夹层，且经TEVAR治疗的患者资料，包括影像学表现、术前处理措施、手术时机、预后情况。结果36例患者均先控制血压、心率后依据病情需要行TEVAR，完整封闭主动脉夹层破口，RIMH予以密切观察，其中11例在发病2周内行TEVAR，术后2例患者发生进一步逆撕或新发主动脉弓部夹层；25例在发病2周后行TEVAR，1例发生术后进一步逆撕。结论破口位于降主动脉合并RIMH的主动脉夹层患者，仅应用TEVAR封闭主动脉夹层破口是可行的，但应尽量在发病2周后进行。

Objective To analyse the clinical features of the aortic dissection with intimal tears in the descending aorta and retrograde intramural hematoma (RIMH), and to explore the clinical experience of thoracic endovascular aortic repair (TEVAR)for these diseases. Methods From January 2011 to May 2014, 36 patients were diagnosed with aortic dissection with intimal tears in the descending aorta and RIMH by CT angiography at the Department of Thoracic Cardiovascular Surgery , Wuhan General Hospital of Guangzhou Command. The clinical data, including the imaging findings, pre-operativetreatment, timing of surgery, and prognosis were retrospectively analyzed. Results All the 36 cases received treatment of hypertension and lowering of heart rate, followed by TEVAR to cover the entry tears, with RIMH being closely observed. TEVAR was performed within 2 weeks in 11 patients, among whom 2 developed retrograde dissection or new aortic arch dissection occurred in 2 cases; TEVAR was performed beyond 2 weeks in 25 patients, and retrograde dissection occurred in one case. Conclusion TEVAR for aortic dissection patients with intimal tears in the descending aorta and RIMH is feasible, and should be performed 2 weeks after onset.