主动脉腔内隔绝术治疗慢性复杂降主动脉夹层疗效分析  

Effect of endovascular aortic repair of chronic complex descending aortic dissection

作　　者：李娜[1] 杜占奎 王效增[1] 王雅[1] 顾若曦 刘晓江[2] 王希哲[3] 

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016 [2]沈阳军区总医院麻醉科,辽宁沈阳110016 [3]沈阳军区总医院普通外科,辽宁沈阳110016

出　　处：《临床军医杂志》2016年第5期480-483,共4页Clinical Journal of Medical Officers

基　　金：辽宁省科技计划项目(2012225009)

摘　　要：目的探讨主动脉腔内隔绝术治疗慢性复杂降主动脉夹层的疗效及安全性。方法回顾性分析自2002年2月至2014年3月沈阳军区总医院收治的86例慢性复杂降主动脉夹层患者临床资料,主动脉腔内隔绝术后近期、远期疗效及并发症发生率。结果所有86例患者手术成功率为100%,共植入带膜支架91枚,其中植入单枚带膜支架81例,植入2枚支架5例。支架平均直径(34.0±4.2)mm,平均长度(126.0±33.2)mm。造影剂少许内漏3例;三度房室传导阻滞合并阵发性房颤植入永久起搏器1例;因破口邻近左锁骨下动脉开口,带膜支架近心端部分封闭左锁骨下动脉18例(20.9%),完全封闭左锁骨下动脉10例(11.6%),术后均无椎基底动脉缺血症状及左上肢血供异常。联合冠状动脉介入治疗7例(8.1%),住院期间无心脏不良事件发生。57例患者接受随访,平均随访时间(62.8±34.7)个月,随访期内9例死亡,病死率为10.5%(9/86)。其中,2例(2.3%)因夹层相关疾病死亡,3例(3.5%)心源性死亡。术后6个月复查主动脉CTA,所有随访患者支架贴壁良好,无变形或移位,真腔内径扩大,假腔内径缩小,血肿部分完全吸收,3例内漏患者内漏自行封闭。结论主动脉腔内隔绝术治疗慢性复杂降主动脉夹层安全、有效。Objective To explore the efficacy and safety of endovascular aortic repair（ EVAR） of chronic complex descending aortic dissection. Methods A retrospective study was performed on 86 cases of patients with chronic complex descending aortic dissection received EVAR in The General Hospital of Shenyang Military Region from February 2002 to March 2014. Clinical data, postoperative short and long term effects and incidence of complications were analyzed. Results All the operations were successful. A total of 91 covered-stents（ 81 single, 5 double）were implanted within mean diameter（ 34.0 ± 4. 2 ）mm and mean length （126.0±33.2 ）mm. There were 3 cases of low dose contrast agent endoleak;1 case of permanent pacemaker implantation;18 cases （20. 9% ）of left subcla- vian artery were part covered by the proximal section of the graft and all covered 10 cases（ 11.6% ） ,there were no vertebra-basilar ar- tery ischemia or ischemic symptom of left upper extremity ;7 cases（ 8.1% ）received combined coronary intervention, no adverse cardiac events during hospitalization. Totally 57 cases accepted follow-ups,the mean follow-up duration was （62. 8 ±34. 7 ）months;9 cases of death during the follow-up period（fatality rate was 10. 5% ） ,including 2 cases of aortic vascular rupture death（2. 3% ） and 3 cases of cardiac death（3.5 % ）. After six months, aortic CTA demonstrated that all the stents were in complete apposition without migration or twist, the inner diameter of true lumen expanded while that of false lumen reduced,the hematoma part completely absorbed and the en- doleak closed by itself. Conclusion EVAR is effective and safe for chronic complex descending aortic dissection.

关 键 词：主动脉夹层 复杂夹层 腔内隔绝术 慢性病 

分 类 号：R543.1[医药卫生—心血管疾病]