DeBakey Ⅲ型主动脉夹层腔内隔绝术后内瘘形成的形态特点与原因  

Features and causes of leakage after endovascular graft exclusion in patients with DeBakey Ⅲ aortic dissection

作　　者：崔燕海[1] 张红丹[1] 黄美萍[1] 刘辉[1] 李景雷[1] 梁长虹[1] 

机构地区：[1]广东省医学科学院广东省人民医院放射科,广东广州510080

出　　处：《中国介入影像与治疗学》2012年第4期246-249,共4页Chinese Journal of Interventional Imaging and Therapy

基　　金：广东省科技支撑计划(2009B030801257);广东省医学科研基金(B2011015)

摘　　要：目的探讨DeBakeyⅢ型主动脉夹层腔内隔绝术后内瘘形成的特点与原因。方法收集98例DeBakeyⅢ型主动脉夹层腔内隔绝术后患者,其中22例术后CT随访发现内瘘形成;在其余76例中随机抽取22例无内瘘患者进行回顾性对比分析。对所有病例均采用多种三维图像后处理方法,立体显示内瘘情况,观察内瘘位置、支架形态、随访中的变化等,并对其形成原因进行探讨。结果 22例患者共形成23个内瘘,其中Ⅰ型内瘘14例(Ⅰa、Ⅰb型各7例),Ⅱ型2例,Ⅲ型6例(Ⅲa型1例、Ⅲb型5例)。内瘘处于1环之内者占54.54%(12/22),2环之内者占27.27%(6/22),近心端10例,占45.45%(10/22)。所有患者的支架直径均与主动脉适合;内瘘处支架局部成角2例、支架断裂1例、支架整体扩张成形不良9例。较小的内瘘可自然愈合或随访过程中无变化(5/7,71.43%),1例假腔破裂形成假性动脉瘤。无内瘘患者支架整体扩张成形不良发生率(2/22,9.09%)低于内瘘患者(9/22,40.91%),差异有统计学意义(χ2=5.939,P=0.015)。结论 CT能清晰显示DeBakeyⅢ型主动脉夹层腔内隔绝术后内瘘的形态特点,有利于改进技术,降低内瘘的发生率。Objective To investigate the features and causes of leakage after endovascular graft exclusion（EVGE） in patients of DeBakey Ⅲ aortic dissection.Methods Totally 98patients with DeBakey Ⅲ aortic dissection who underwent EVGE were enrolled and examined by CT.Twenty-three leakages were found in 22patients.CT features of these leakages were observed,including the classification,the site of leakage,the shape of stent-graft and the changes during following up.Three dimensional reformatting was performed to display the leakages and the stent-grafts visually and accurately.The features of stents in patients with leakages were compared with those in another 22patients without leakages.Results Of 23the leakages in the 22patients,typeⅠ was found in 14cases（Ⅰa 7cases andⅠb 7cases）,typeⅡin 2cases and type Ⅲin 6cases（Ⅲa 1case andⅢb 5cases）.A totally of 54.54%（12/22） leakages located in the first loop and 27.27%（6/22） in the second loop.Leakages at the proximal was accounted for 45.45%（10/22）.Two stents angulations,1fracture and 9dys-shaping were found at the leakage sites,respectively.Small leakages kept no changes or spontaneous closure（5/7,71.43%）,while 1case of leakage developed pseudoaneurysm due to dissection breaking.In patients without leakages,the incidence of stent dys-shaping（2/22,9.09%） was significant lower than that in patients with leakage（9/22,40.91%,χ 2 =5.939,P=0.015）.Conclusion CT can display the characteristics leakage in patients with DeBakeyⅢ aortic dissection after EVGE,therefore contributing to improvement of EVGE technique,advancement of stent graft and decreasement of leakage.

关 键 词：腔内隔绝术 主动脉夹层 体层摄影术 X线计算机 

分 类 号：R543.1[医药卫生—心血管疾病] R814.42[医药卫生—内科学]