腔内修复治疗马方综合征患者Stanford B型主动脉夹层的效果分析  

Endovascular treatment for Stanford type B aortic dissection in Marfan syndrome patients:a series of 23 cases

作　　者：蒋小浪 刘浩 邹凌威 陈斌 蒋俊豪 郭大乔 徐欣 董智慧 符伟国 Jiang Xiaolang;Liu Hao;Zou Lingwei;Chen Bin;Jiang Junhao;Guo Daqiao;Xu Xin;Dong Zhihui;Fu Weiguo(Department of Vascular Surgery,Zhongshan Hospital,Fudan University,National Clinical Research Center for Interventional Medicine,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院血管外科国家放射与治疗临床医学研究中心,上海200032

出　　处：《中华外科杂志》2024年第5期438-442,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金(82270507);复旦大学临床名医培育工程(2021MYPY002)。

摘　　要：目的探讨未接受过主动脉弓部置换的马方综合征患者行胸主动脉腔内修复(TEVAR)治疗Stanford B型主动脉夹层(TBAD)的临床效果。方法本研究为回顾性病例系列研究。回顾性分析2009年1月至2019年12月在复旦大学附属中山医院血管外科行TEVAR治疗TBAD的未接受过主动脉弓部置换的23例马方综合征患者的临床资料。男性15例,女性8例;年龄(38.0±11.0)岁(范围:24~56岁),其中12例患者有升主动脉手术史。分析患者的手术情况、围手术期并发症和再干预情况,采用Kaplan-Meier曲线分析术后生存情况。结果患者技术成功率为91.3%(21/23)。2例手术失败患者,1例出现少量Ⅰa型内漏,随访期间消失;1例出现支架远端内膜脱套,再次植入第2枚支架,两枚支架重叠处出现少量Ⅲ型内漏,随访期间消失。围手术期死亡1例(4.3%)。随访时间[M(IQR)]60(48)个月(范围:12~132个月)。7例患者需要再干预,原因包括远端支架源性新破口3例,远端瘤样扩张2例,Ⅰa型内漏1例及近端逆行撕裂性A型夹层1例。患者5年累积生存率为86.7%(95%CI:86.6%~86.8%),免于主动脉再干预率为81.8%(95%CI:61.8%~92.8%)。结论在未接受过主动脉弓部置换的马方综合征患者中,TEVAR治疗TBAD具有较高的技术成功率和较低的围手术期并发症发生率。Objective To evaluate the clinical outcomes of thoracic endovascular aortic repair(TEVAR)in the treatment of Stanford type B aortic dissection(TBAD)in Marfan syndrome patients who had no history of aortic arch replacement.Methods This is a retrospective case-series study.From January 2009 to December 2019,the clinical data of Marfan syndrome patients who underwent TEVAR for TBAD at the Department of Vascular Surgery were collected.A total of 23 patients were enrolled,including 15 males and 8 females.The age was(38.0±11.0)years(range:24 to 56 years).Among them,12 patients had history of ascending aortic surgery.Details of TEVAR,perioperative complications and reintervention were recorded and survival rate was analyzed by Kaplan-Meier curve.Results Technical success was 91.3%(21/23).Two patients with technical failure were as follows:one patient had type Ⅰa endoleak at the completion angiography,which healed spontaneously during the follow-up,and the other patient suffered aortic intimal intussusception after the deployment of the first stent-graft,and the second stent-graft was deployed.However,type Ⅲ endoleak was detected,which disappeared during the follow-up.One patient died during hospitalization.The median follow-up time(M(IQR))was 60(48)months(range:12 to 132 months).Reintervention was performed on 7 patients,including 3 distal stent-graft-induced new entry,2 distal aortic dilation,1 Ⅰa endoleak and 1 retrograde type A aortic dissection,respectively.Five-year cumulative survival rate was 86.7%(95%CI:86.6%to 86.8%)and the 5-year freedom from reintervention rate was 81.8%(95%CI:61.8%to 92.8%).Conclusions TEVAR is feasible in the treatment of TBAD in Marfan syndrome patients who has no history of aortic arch replacement.It has high technical success rate and low perioperative complication.

关 键 词：马凡综合征 主动脉疾病 B型主动脉夹层 腔内修复 

分 类 号：R543.1[医药卫生—心血管疾病]