两段式覆膜支架治疗B型主动脉夹层的研究  

An innovative research of endovascular repair for type B aortic dissection using two covered.stent grafts

作　　者：彭明亮[1] 黄小勇[1] 吴文辉[1] 薛玉国[1] 韩晓峰[1] 曾庆龙[1] 蒲俊舟[1] 刘浩[1] 宁一[1] 黄连军[1] PENG Mingliang HUANG Xiaoyong WU Wenhui XUE Yuguo HAN Xiaofeng ZENG Qinglong PU Junzhou LIU Hao NING Yi HUANG Lianjun(Department of International Therapy, Be~iing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart,Lung and Blood Vessel Diseases, Beijing 100029, China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所介入诊疗科,100029

出　　处：《心肺血管病杂志》2016年第10期799-802,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：医管局腔内两段式覆膜支架治疗Stanford B型主动脉夹层前瞻性研究基金（XM201306）

摘　　要：目的：探讨两段式覆膜支架腔内修复术（TEVAＲ）治疗Stanford B型主动脉夹层（TBAD）的疗效。方法：分析2013年3月至2015年3月间，在本中心采用两段式覆膜支架TEVAＲ术治疗的61例TBAD患者的临床影像及术后随访资料。适应证：①胸降主动脉段主动脉弯曲变形;②胸降主动脉存在多发破口;③主动脉远端锚定区真腔因假腔挤压而过细。结果：应用两段式覆膜支架TEVAＲ术治疗的TBAD共61例。术后平均随访（23. 6 ± 7. 4）个月，围手术期死亡1例（1. 6%），支架远端新发破口1例（1. 6%） ，支架远端贴壁不良3例（4. 9%） ，支架段假腔完全血栓化率91. 8%（55 /61），其中支架段假腔完全消失率41. 8%（23 /55），主动脉完全重塑率7. 3%（4 /55）。结论：采用两段式覆膜支架腔内修复术治疗Stanford B型主动脉夹层实现了主动脉夹层腔内治疗远端锚定区的精确选择，近中期疗效安全满意，中、远期疗效尚需远期随访。Objective：To investigate the effect of treatment of type B aortic dissection using two cov- ered-stem grafts. Methods： Clinical ,imaging and postoperative follow-up data of 61 cases with Stanford type B aortic dissection treated by TEVAR using two eovered-stent grafts from March 2013 to 2015 march in our center were analyzed. The indications of endovascular repair ：（1）the bending deformation of thoracic-descending aorta （2） thoracic-descending aorta existing multiple ruptures （3）collapse of true lumen by oppressing of false lumen at the distal end of stent. Long diarneter,area of the true lumen at distal segment of stent and the Length of covered stents were measured. The oversize ratio based on diameter, area were calculated respectively. Thoracoabdomi- nal aortic CTA were examined at postoperative 7day, 3 month, 6 month, l year and thereafter every year. The effect of endovascular repair, condition of false lumen thrombosis, distal stent graft-induced new entry and other related complications were studied. Results： A total of 61 cases using two covered-stent grafts to treat Stanford type B aortic dissection A total of 5 different types of stent combination, Valiant ＋ Grikin two eovered-stent graft are 40 cases （65.6%） ,Zenith ＋ Grikin are 10 cases （ 16. 4% ） ,Grikin ＋ Grikin are 8 cases （ 13.1% ） ,Hercu- les ＋ Grikin are 2 cases （3.3%） ,TAG ＋ Grikin are 1 cases （ 1.6% ）. The mean followed up was （23.6 ±7.4） months （range 12-35 months）. The mean length of the stent graft was （213.9 ±27.4）mm and the Median （in- terquartile rang） of oversize ratio of diameter and area at the distal of stem werel0.7% （ 8.5% , 14. 0% ）,38.0% （28.3% , 70. 8% ） , respectively. I ease （ 1.6% ） died during perioperative period, the distal stent graft-induced new entry in 1 case （ 1.6% ） , distal stent malapposition in 3 cases（4. 9% ）. Complete thrombosis of the segment of stenl was 91.8% （55/61） , ineluding complete disappear of false lumen of th

关 键 词：主动脉夹层 腔内修复术 大锥度覆膜支架 远端支架源性新发破口 

分 类 号：R54[医药卫生—心血管疾病]