多层螺旋CT造影在主动脉病变腔内修复术后随访的价值

目的:探讨多层螺旋CT血管造影(multi-detector rowspiral computed tomography angiography,MDCTA)及后处理技术在主动脉覆膜支架腔内修复术(transluminal stent-graft placement,TSGP)术后随访的临床应用价值。方法:21例接受TSGP主动脉疾病患者,包括:Stanford B型夹层13例,真性动脉瘤3例,假性动脉瘤2例,弓降部穿透性溃疡1例,胸主动脉瘤合并局限性夹层1例,胸主动脉瘤合并Stanford B型夹层1例,术后采用MDCTA进行随访,平均随访13个月(1~24个月)。采用轴位图像与多种重建图像相结合来显示支架形态、术前术后主动脉管腔情况的变化和有无并发症。结果:13例主动脉夹层覆膜支架置入后:所有患者均真腔扩大,假腔减小或消失并伴血栓形成,支架未发现移位或断裂;共3例(14%)随访中发现内漏,1例Ⅱ型内漏,建议随访观察;1例术后8个月复查新发现支架近端Ⅰ型内漏,密切随访2个月后患者出现胸痛,复查CT内漏增多,转外科治疗。1例腹主动脉瘤术后1月复查发现Ⅲ型内漏。所有患者介入术后CT随访图像均满足临床诊断需要。结论:MDCTA对主动脉覆膜支架置入术后随访较其他检查手段具有多方面的优越性,能及时观察术后疗效、发现并发症,对主动脉疾病覆膜支架腔内修复术后随访具有重要价值。     

应用国产覆膜支架治疗Stanford B型主动脉夹层动脉瘤

目的:评价应用国产覆膜支架治疗B型主动脉夹层动脉瘤的安全性及临床疗效.方法:自2005 - 05～2009 - 12对38例Stanford B型主动脉夹层动脉瘤实施了腔内隔绝术.其中男29例,女9例;年龄(54±12)岁.经CT增强扫描或磁共振成像(MRJ)确诊.切开左或右股动脉置入覆膜支架,封堵胸主动脉破裂口,置入后造影检查证实疗效,随访行CT或MRI检查.结果:支架置入全部成功,术后即刻造影36例无内漏,2例见少量内漏.降主动脉及腹主动脉真腔均明显扩大,远端降主动脉及分支供血均有不同程度改善.住院期间及随访1年内无患者死亡,发生主动脉腔内隔绝术后综合征3例.结论:应用国产覆膜支架腔内隔绝治疗B型主动脉夹层动脉瘤是一种操作简便、安全、成功率高、并发症少,疗效可靠的介入方法.     

Stanford B型主动脉夹层腔内修复术治疗体会

目的:探讨腔内修复术治疗Stanford B型主动脉夹层的效果。方法:对2005-09~2010-02期间18例Stanford B型主动脉夹层患者实行血管造影和血管腔内带膜支架植入手术治疗,术后3、6、12个月行CTA检查,观察手术疗效以及有无狭窄、移位和扭曲等术后并发症。结果:无中转开胸手术。除1例再发Stanford A型夹层破裂死亡外,其余患者均顺利出院。结论:主动脉夹层腔内修复术治疗Stanford B型主动脉夹层是一种安全有效的方法,早期结果满意,中远期效果还有待观察。     

血管覆膜支架置入治疗胸主动脉夹层动脉瘤

目的:介绍覆膜支架血管内置入治疗胸主动脉夹层动脉瘤(TADA)的初步经验。方法:本组4例Debakey B型胸主动脉夹层动脉瘤,经CT或MR增强检查确诊。经股动脉置入覆膜支架,封堵胸主动脉破裂口,置入后造影检查证实疗效,术后随访采用彩超或增强CT检查。结果:4例患者共成功置入7个支架,1例术后支架远端出现内漏,6个月后内漏自行封闭;1例并发的腹主动脉瘤随访2个月无变化;随访2~18个月,所有患者内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常。结论:覆膜支架血管内置入治疗胸主动脉夹层动脉瘤的近期疗效满意。     

主动脉夹层动脉瘤的血管内支架治疗

目的评价血管内支架置入治疗主动脉夹层动脉瘤的安全性和临床疗效。方法48例Stanford B型主动脉夹层动脉瘤患者行腔内修复术。所有患者在DSA下行左肱动脉穿刺插管、造影,了解主动脉真、假腔,夹层裂口及其与重要血管分支位置关系。腹股沟区纵切口显露股动脉,送入人工血管输送器至病变处,准确定位后,释放人工血管进行腔内修复。术后复查造影,观察真、假腔血液动力学变化,内脏及下肢动脉供血的改变。结果48例患者一次性成功置入人工血管支架,2例支架未能完全封堵漏口,内漏明显,手术成功率95.8%。支架置入后假腔血压下降,机体脏器缺血状况改善,临床症状好转或消失。结论支架性人工血管腔内修复术治疗主动脉夹层动脉瘤安全可行、效果明显,值得临床进一步推广。     

单分支型主动脉覆膜支架治疗Stanford B型主动脉夹层的临床价值

【摘要】 目的 探讨单分支型主动脉覆膜支架在Stanford B型主动脉夹层单纯腔内隔绝治疗中的临床价值。 方法 2017年7月至2018年10月采用国产CastorTM单分支型主动脉覆膜支架行单纯腔内隔绝治疗19例Stanford B型主动脉夹层患者,观察术后即时血管造影结果。术后1个月门诊随访,术后6个月复查主动脉CTA。以手术成功率、假腔消失率和分支支架通畅率为有效性终点指标,观察相应不良事件。 结果 19例患者支架均释放成功,技术成功率100%。围手术期无不良事件发生。随访期患者无死亡,4例门诊随访时出现左上肢缺血症状,经对症治疗后缓解。无严重内漏发生,分支支架通畅率100%,夹层假腔均出现血栓化,假腔直径平均缩小（10.3±1.2） mm（肺动脉分叉平面）。 结论 单分支型主动脉支架对于近端破口距左锁骨下动脉开口＜15 mm或逆撕至左锁骨下动脉根部的Stanford B型主动脉夹层,是有效的单纯腔内隔绝方法。     

Stanford B型主动脉夹层多型支架介入治疗的临床体会

目的 应用多种类型支架行Stanford B型主动脉夹层介入治疗,探讨扩大介入治疗适应证的可行性.方法 回颐性分析2004年5月-2009年12月,18例Stanford B型主动脉夹层患者行介入性腔内修复术治疗的临床资料.根据CTA和DSA结果,个体化选择合适覆膜支架,透视下将覆膜支架经股动脉导入封闭夹层破口.术后CTA随访观察内漏、支架移位、假腔变化等.结果 18例中2例放置分体式主动脉覆膜支架、1例放置分支型覆膜支架、2例放置预留孔型主动脉覆膜支架,13例放置普通主动脉覆膜支架.1例封堵左锁骨下动脉、2例不全封堵左锁骨下动脉均未出现左上肢和椎基底动脉缺血症状;1例因解剖变异右锁骨下动脉起自主动脉弓而行旁路手术.术后发生8例(44.4%)即刻I型内漏,其中1例腔内修复术后持续I型内漏再次放置支架后进展为Standford A型主动脉夹层瘤而行升主动脉人工血管置换术,其余CTA随访内漏逐渐消失;所有患者均无支架移位、断裂、塌陷以及术后截瘫及脑血管意外发生.结论 采取不同方法延长近端锚定区的距离、应用分体式主动脉支架可扩大介入治疗Standflord B 型主动脉夹层的适应证,且近期疗效好,中、远期疗效有待进一步观察.     

3D打印在复杂主动脉疾病个体化腔内治疗中的应用价值

【摘要】目的：探讨3D打印技术在复杂主动脉疾病个体化腔内治疗中的应用价值。方法：搜集3例复杂主动脉病变,包括病变邻近主动脉弓远端的Stanford B型主动脉夹层（病例1）,病变累及升主动脉但原发破口位于降主动脉的逆撕Stanford A型主动脉夹层（病例2）和解剖迂曲的肾动脉下型腹主动脉瘤（病例3）。通过3D打印模型制定个体化腔内治疗方案。结果：根据3D打印模型制定个体化手术方案,病例1行左锁骨下动脉+左颈总动脉开窗,病例2行单纯腔内修复,病例3行腔内隔绝术;3例患者术中造影均显示无内漏,开窗血管血流通畅,无支架移位、截瘫、神经系统并发症发生。术后随访1年,3例均无内漏,假腔或瘤体血栓机化,无主动脉相关事件发生。结论：3D打印技术有助于复杂主动脉疾病最优化、个体化腔内治疗方案的制定,临床应用前景广泛。     

Stanford B型主动脉夹层支架置入术前MSCTA的诊断价值

目的探讨Stanford B型主动脉夹层支架置入术前多层螺旋CT(MSCTA)检查的诊断价值。资料与方法分析26例Stanford B型主动脉夹层(AD)患者MSCTA表现及临床介入资料。结果通过MSCTA检查发现破裂口情况、主要血管分支假腔供血情况、真假腔形态、双侧髂股动脉情况、并发症等信息,并以此对介入支架置入治疗术前评估及术后预判,与介入实际情况相比较,真实一致。结论 MSCTA对Stanford B型主动脉夹层支架置入术前诊断具有重要意义。     

带膜支架治疗Stanford B型胸主动脉夹层的经验探讨

目的:探讨Stanford B型胸主动脉夹层(TAD)腔内隔绝术一些经验.方法:回顾性分析我院2002年～2005年全麻下行腔内隔绝术的36例Stanford B型胸主动脉夹层患者的资料.结果:所有患者均成功实行了带膜支架腔内隔绝术,未出现死亡现象,内漏9例,右股动脉切开处内膜撕裂3例.结论:带膜支架置入术治疗Stanford B型胸主动脉夹层是一种安全有效的方法,但术中术后并发症的预防是成功的关键.     

覆膜支架治疗降胸主动脉瘤

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。     

Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results

PURPOSE: To evaluate the feasibility and safety of endovascular stent-graft placement in treating Stanford type B aortic dissection. MATERIALS AND METHODS: Seven patients underwent endovascular stent-graft placement for type B aortic dissection. Five patients had acute and two had chronic dissection. In five patients, the proximal entry tear was within 2 cm of the origin of the left subclavian artery, and in two patients it was beyond this site. In three patients, the noncovered proximal portion of the stent-graft was placed across the origin of the left subclavian artery. The efficacy of the procedure was assessed at follow-up studies 3, 6, 12, and 24 months after intervention. RESULTS: The procedure was technically and clinically successful in six patients (86%). The left subclavian artery remained patent in all patients. In two patients with involvement of aortic branches, endovascular stent-graft placement restored adequate blood flow to the compromised branches. One patient was readmitted 1 month later because the dissection extended into the ascending aorta. In all but this patient, closure of the entry tear and thrombosis of the false lumen along the stent-graft were achieved. All false lumina shrank considerably. The mean follow-up time was 14 months (range, 1-25 months). CONCLUSION: Type B aortic dissections within and beyond 2 cm of the origin of the left subclavian artery can be treated safely and effectively by means of endovascular stent-graft placement.     

DSA下经皮带膜支架腔内隔绝术治疗Stanford B型主动脉夹层的临床应用

目的 评价DSA下经皮带膜支架腔内隔绝术治疗Stanford B型主动脉夹层(AD)的价值及临床意义.资料与方法 对20例MSCTZ诊断为Stanford B型AD患者行带膜支架腔内隔绝术(EVGE)治疗.结果 20例Stanford B型AD中,单纯行EVGE治疗共植入支架22枚,支架释放成功率100%,造影复查15例无明显渗漏和假腔显影(75%),5例少许渗漏(25%)以适应性球囊逐段贴覆后渗漏消失, 术后6天因右肾出血伴感染死亡1例, MSCT复查19例无明显支架移位或渗漏,回访3个月生存质量良好.结论 DSA下EVGE治疗Stanford B型AD可有效提高EVGE治疗的成功率和预防并发症的发生.     

带膜支架腔内置入术治疗急性胸腹主动脉夹层

目的 :探讨带膜支架腔内置入术治疗急性胸腹主动脉夹层的应用和疗效。方法 :对 1例急性胸腹主动脉多发破口的主动脉夹层采用带膜支架置入治疗 ,并分析其疗效。结果 :经股动脉置入两枚带膜支架封闭破口成功 ,术后复查彩超和多层螺旋CT示主动脉夹层消失 ,假腔内血栓形成 ,未出现支架移位、狭窄等并发症。结论 :带膜支架腔内置入术是治疗主动脉夹层的有效方法。     

主动脉夹层支架置入术前CT的诊断价值(附9例报告)

目的:探讨主动脉夹层行支架置入术前CT检查的诊断价值及对手术的指导意义.方法:回顾性分析9例主动脉夹层患者的支架置入术及CT影像资料,分析术前CT对支架置入术的指导作用及手术对CT的诊断要求.结果:主动脉夹层支架置入术前行CT平扫、增强及三维重建可较准确地反映主动脉夹层的分型、内膜裂口、周围脏器血供等情况.根据术前CT诊断信息设计手术,8例手术成功,1例术中发现病情发展而中止手术.结论:CT可较准确地诊断主动脉夹层,并为支架置入术提供重要信息.     

Placement of endovascular stent-grafts for emergency treatment of acute disease of the descending thoracic aorta

OBJECTIVE: The aim of this study was to evaluate the feasibility, safety, and effectiveness of endovascular stent-graft placement for the emergency treatment of acute descending thoracic aortic disease. MATERIALS AND METHODS: From January 1996 through November 2001, 18 patients underwent emergency endovascular stent-graft placement for various types of acute descending thoracic aortic disease. Five patients had Stanford type B aortic dissection, six had traumatic ruptures of the thoracic aorta, five had ruptured aortic aneurysms, and two had penetrating atherosclerotic aortic ulcers. All patients presented with life-threatening symptoms requiring treatment with stent-grafts from the emergency kit. All were at high surgical risk due to serious comorbidities. The efficacy of the procedure was assessed at follow-up studies before discharge and at 3, 6, and 12 months after intervention and yearly thereafter. RESULTS: The primary technical success rate was 78%. Four patients had primary perigraft leaks. The secondary technical success rate was 83%. One patient died 20 hr after intervention from stent-graft-related causes. Follow-up studies revealed stent-graft migration in one patient. Progression of disease was observed in one patient treated for dissection and in both patients treated for penetrating ulcers. One patient died 7 months after intervention of unknown reasons; all other patients are alive. The mean follow-up time was 17.4 months (range, 0-38 months). CONCLUSION: Emergency repair of acute descending thoracic aortic disease with stent-graft placement can be successfully accomplished and may be a promising alternative to open-chest surgery, especially in patients at high risk.     

Non-surgical treatment of aortic aneurysms and dissections: indications, strategies and outcome

PURPOSE: The endovascular treatment of the thoracic aorta is an effective alternative to open surgical repair and offers a therapeutic option even to patients at high risk for surgery. Our experience in the treatment of different diseases of descending thoracic aorta is reported. MATERIAL AND METHODS: Between July 1997 and January 2001, 50 patients were selected for endovascular treatment: 36/50 patients presented high risk for conventional surgery. Six patients presented clinical and imaging features suggesting impending rupture and were treated on emergency basis. The stent-graft prosthesis was individually manufactured or selected on the basis of spiral CT or MRI measurements. RESULTS: Endovascular stent positioning and deployment was technically successful in 49 cases. In one patient the tortuosity of the aortic arch prevented graft deployment. Complete aneurysm exclusion was achieved in 48 cases as assessed by post-procedure angiography and TEE. One proximal endoleak was noted and surgical conversion was performed 40 days later. There were no intraoperative mortality or complications. One patient presented extension of dissection at the 8th postoperative day and required of surgical repair. CT scan showed an endoleak in 4 cases that sealed spontaneously in three cases while the fourth case was treated by graft extension. In the long term two secondary endoleak were observed (12 and 24 months after the procedure). CONCLUSIONS: Endovascular stent-graft repair provides a less invasive opportunity to patients affected by thoracic aortic disease. Careful cases selection is the first postulate for the efficacy and safety of the procedure.     

Placement of endovascular stent-grafts for emergency repair of acute traumatic aortic rupture: a single-centre experience

The aim of this retrospective study was to evaluate mid- and long-term results of endovascular stent-graft placement for emergency repair of acute traumatic thoracic aortic rupture. From 1996 through 2005, 22 consecutive patients (mean age: 38.7 years) underwent endovascular repair of acute traumatic thoracic aortic rupture located at the aortic isthmus in most cases. All patients were at high surgical risk due to severe associated injuries. The endografts were inserted via femoral or iliac artery access under fluoroscopic guidance. Follow-up was performed postinterventionally, at 6 and 12 months and yearly thereafter, and included clinical examination and computed tomography (CT) scans. Technical and clinical success rates were 86.3%. Mean follow-up was 31.7 months. Three patients developed early type I endoleak due to the inability of the rigid graft to adapt to the curved aortic contour. In two of them conversion to open surgery was necessary. One patient had late type I endoleak and died. No other complications were observed. The outcome was successful in most patients. The mid- and long-term results of our current study are promising. However, early type I endoleak represents a problem, especially in adolescent patients with a marked curvature of the aortic arch.