覆膜支架治疗降胸主动脉瘤  

Endoluminal stent-graft management for type B aortic dissection and descending thoracic aortic aneurysm

作　　者：滕皋军[1] 邓钢[1] 何仕诚[1] 郭金和[1] 方文[1] 朱光宇[1] 李旭东[1] 刘志勇[1] 

机构地区：[1]东南大学附属中大医院,南京210009

出　　处：《介入放射学杂志》2006年第3期137-141,共5页Journal of Interventional Radiology

摘　　要：目的评估覆膜支架治疗术治疗Stanford B型主动脉夹层和降主动脉瘤的安全性和近期疗效。方法2003年3月至2005年9月期间,共29例Stanford B型主动脉夹层和2例降胸主动脉瘤患者接受覆膜支架治疗术,所有患者均有高血压病史,其中急性发病27例.本组采用两种支架(Mdtronic Talent15例,上海微创Aegis 16例),术后采用CTA进行定期随访。结果所有支架均成功按预期定位释放,术后即刻DSA复查显示23例夹层患者近端破裂口完全封闭,2例降主动脉瘤也完全隔离,6例发现有内漏;术后7 d CTA复查发现16例假腔内完全血栓形成,12例近端假腔形成血栓,远端假腔仍开放。结论覆膜支架术治疗Stanford B型主动脉夹层和降主动脉瘤安全、有效,可替代外科手术。但覆膜支架术的确切长期疗效尚待进一步的大样本、前瞻性对照研究才能确定。Objective To evaluate the feasibility and short-term early results of endoluminal stent-graft placement in the Stanford B type aortic dissection and the descending thoracic aortic aneurysms. Methods From March 2003 to September 2005, a total of 31 patients underwent placement of endovascular stent-grafts,including the descending thoracic aortic aneurysm （ n=2 ） and Standford B type aortic dissection （ n=29 ） . All patients had hypertension, with urgent onset of progressive thoracic pain in 27. Two kinds of stent-graft were used in this series： the Talent （Medtronic） in 15 and Aegis （Microportmedicine, Shanghai） in 16 patients. Follow-up was carried out with clinical observations and CTA. Results Stent-graft implantation for the proximal entry closure was successfully performed in all patients. The DSA of immediately post deployment of the stent-graft showed complete occlusion the proximal entry tear in 23/29 patients with dissection, and complete isolation of the aneurysm in two patients with aortic aneurysm. Endoleak was revealed in 6 patients with dissection. No major complications related to the procedure were encountered. Conclusions The interventional placement of stent-graft for Type B aortic dissection and descending thoracic aortic aneurysm is safe with satisfactory short-term outcomes. Nonetheless, longer follow-up is highly desirable to assess its real advantages.

关 键 词：主动脉夹层 覆膜支架 介入手术 

分 类 号：R543[医药卫生—心血管疾病]