腔内隔绝术治疗主动脉瘤23例疗效观察

目的：探讨腔内隔绝术治疗主动脉瘤的疗效。方法回顾性分析23例经腔内隔绝术治疗主动脉瘤患者的一般临床资料、手术情况、手术结果和术后随访情况。结果23例患者均手术成功,术后造影见主动脉瘤体（或夹层假腔）消失,支架无移位,无发生截瘫;1例术后18h突发脑血管意外抢救无效死亡,总治愈率为95．7％（22／23）。术后并发症主要为内漏,其中Ⅰ型内漏3例,Ⅱ型内漏2例,发生率为21．7％（5／23）,急性肾功能不全4例（17．4％）;脑卒中1例,发生率为4．3％（1／23）。随访4个月-60个月,2例失访。随访期间死亡2例,死亡原因1例为恶性肿瘤转移,另1例为复发性降主动脉夹层破裂大出血：随访期经复查,5例早期并发内漏者内漏消失,假腔血栓形成。结论腔内隔绝术治疗主动脉瘤安全而且有效。     

血管腔内隔绝术治疗DeBakey Ⅲ型动脉瘤疗效分析

目的探讨血管腔内隔绝术治疗降主动脉夹层动脉瘤的方法和疗效。方法DeBakeyⅢ型主动脉夹层患者8例,进行血管腔内隔绝术(其中2例为DeBakeyⅢa型,6例为DeBakeyⅢb型)。结果8例均成功行血管腔内隔绝术,出现I型内漏4例,经球囊扩张后2例内漏消失,2例仍有少量内漏。进行22～36个月的临床随访。1例于术后23个月死于颅内出血,余7例均存活。结论血管腔内置入带膜支架型人工血管是治疗主动脉夹层动脉瘤简便、安全、有效的方法。     

国产覆膜支架治疗DeBaKeyⅢ型夹层动脉瘤的疗效分析

目的总结评价国产覆膜支架腔内隔绝术治疗胸主动脉夹层动脉瘤的手术适应证、临床疗效。方法对38例DebaKeyⅢ胸主动脉夹层患者行腔内隔绝术的临床资料进行回顾性分析,术后对所有患者行CT随访,评价其临床改善程度与真假腔的变化。结果37例患者全麻下均成功进行了覆膜支架血管腔内隔绝术,共使用40个血管支架,术中造影显示夹层裂口完全封闭或内漏明显减少。3例术中出现明显的内漏,再置入1枚短支架后内漏消失;1例因置入支架后血压下降,急诊行开胸手术人工血管置换术,15d痊愈出院。其余患者未出现与夹层及手术有关的并发症。术后3～24个月随访,所有患者复查螺旋CT或64排CT,假腔内血栓形成,真腔增大,未发现内漏、瘤体扩大及支架移位。结论应用覆膜支架腔内隔绝术治疗DeBaKeyⅢ型主动脉夹层动脉瘤创伤小、安全有效、成功率高、术后恢复较好,尤为适用于老年高危患者及亚急性或慢性期的患者。     

腔内隔绝术对DeBakeyⅢ型主动脉夹层的治疗

目的:总结腔内隔绝术治疗DeBakeyⅢ型主动脉夹层适应证的选择、临床疗效以及探讨并发症的防治原则。方法:采用TALENT带膜支架施行主动脉腔内隔绝术治疗DeBakeyⅢ型主动脉夹层患者22例(其中1例病因为EhlersDanlos综合征),从发病至手术间隔时间为7h～10年。并发高血压18例,冠心病、心绞痛3例,2型糖尿病1例,脑卒中史2例,并发胸腔积液2例。结果:22例患者共置入23枚覆膜支架。术中无一例死亡。3例术中出现明显内漏,2例予球囊扩张,1例再置入1枚短支架后内漏消失。所有患者主动脉夹层破口均成功隔绝,技术成功率达100%。1例EhlersDanlos综合征患者,在成功隔绝主动脉后出现支架置入所经股动脉、髂外动脉、髂总动脉、腹主动脉广泛血管撕裂,失血性休克,予以抗休克处理及施行急诊人造血管置换术,患者病情好转恢复。术后3～6个月随访,所有患者复查螺旋CT示假腔径缩小并见腔内血栓形成,真腔径增大,无瘤体破裂、内漏及支架移位等并发症发生。结论:腔内隔绝术治疗DeBakeyⅢ型主动脉夹层具有技术可靠、创伤小、术后恢复快、成功率高等优点,尤其适用不能耐受传统开胸手术的老年高危患者。施行腔内隔绝术治疗EhlersDanlos综合征的血管并发症、手术并发症及疗效有待进一步观察。     

腔内隔绝术治疗112例Stanford B型主动脉夹层动脉瘤患者疗效观察

目的评价主动脉夹层腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤的院内及长期临床疗效。方法选择行主动脉腔内隔绝术治疗Stanford B型主动脉夹层患者112例。经股动脉切开置入覆膜支架封堵胸主动脉破裂口,置入后冠状动脉造影检查证实疗效,术后随访平均(39±18)个月。分析其临床特点及疗效。结果手术成功112例,共置入覆膜支架119枚。左锁骨下动脉完全被封闭8例,合并严重狭窄病变的冠心病患者完成PCI 16例,主动脉腔内隔绝术后综合征19例,术后1个月内夹层破裂死亡3例。随访3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。术后明显残余内漏10例,3个月自行封闭。术后6个月,再发升主动脉夹层3例,其中行升主动脉外科手术1例,截瘫1例,胃癌多器官转移死亡1例。术后1年迟发性内漏1例。结论腔内隔绝术治疗Stanford B型主动脉夹层动脉瘤的院内及长期疗效满意。     

腔内隔绝术治疗主动脉夹层动脉瘤107例分析

目的 探讨应用覆膜支架腔内隔绝术治疗主动脉夹层动脉瘤的方法和效果.方法 对107例(男88例,女19例,年龄28～83岁)主动脉夹层动脉瘤腔内隔绝术患者的临床资料进行回顾性分析.术前采用CT血管成像(computerized tomography angiography,CTA)、经胸心脏超声(transthoracic echocardiography,TTE)、磁共振血管成像(magnetic resonance aniography,MRA)等技术对主动脉夹层动脉瘤进行评估.术中穿刺左肱动脉行主动脉造影了解破口的位置及撕裂的范围,在数字减影血管造影(digital subtraction angiography,DSA)监视下经股动脉将覆膜支架送入胸降主动脉封闭夹层破口.结果 107例成功进行了主动脉夹层动脉瘤腔内隔绝术.术后主动脉造影证实夹层裂口完全封闭或内漏明显减少,无中转开胸手术.术后随访1～48个月,术后1个月3例死亡.104例行CTA复查,术后3个月,所有患者内膜破裂口封闭,胸降主动脉真腔扩大,假腔内血栓形成,支架位置、形态正常.术后6个月,1例再发生升主动脉夹层,置入一枚支架后后假腔消失.术后1年,主动脉均未见病变.结论 覆膜支架腔内隔绝术是治疗主动脉夹层动脉瘤的安全、有效的方法,近期疗效好.手术死亡率和并发症发生率低,手术成功率和生存率高.     

腔内隔绝术治疗Stanford B型主动脉夹层210例分析

目的评价腔内隔绝术治疗Stanford B型主动脉夹层的疗效和安全性。方法收集2002年4月至2010年10月于沈阳军区总医院行主动脉腔内隔绝术治疗Stanford B型主动脉夹层210例资料,年龄(53.4±11.1)岁。经股动脉切开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;合并严重冠状动脉狭窄者于腔内隔绝术后3～7 d完成经皮冠状动脉介入治疗(PCI)。观察介入治疗的疗效。结果腔内隔绝术成功率100%,共置入208枚主体覆膜支架及13枚cuff支架。20例患者完全封闭左锁骨下动脉开口,无左上肢及脑供血不足症状。26例患者行PCI成功率100%,对32支靶血管共置入36枚冠状动脉支架,无出血、心肌梗死等并发症。患者术后平均随访(60±35)个月,随访率96.6%(201/208)。33例出现腔内隔绝术后综合征,13例术后有残余内漏,其中8例残余内漏于术后3个月自行封闭。术后半年,3例再发升主动脉夹层,1例发生截瘫。术后1年,1例发生迟发性内漏。行PCI患者无主要心脏不良事件发生。本组共死亡6例,其中与腔内隔绝术有关死亡4例,分别发生在术后1 h、术后5 d、出院后2 d、15 d,与腔内隔绝术无关死亡2例,分别问胃癌晚期和肺心病。结论腔内隔绝术治疗Stanford B型主动脉夹层近期及长期疗效好、并发症低。合并冠心病患者择期二次行PCI安全可行。     

腔内隔绝术治疗Stanford B型主动脉夹层

对17例S tan ford B型主动脉夹层患者行腔内隔绝术(EVGE)。均成功植入血管支架,13例夹层入口封堵完全,即刻内漏4例,经处理2例内漏消失,另2例轻微内漏未处理。术后随访2~56(14.5±11.6)个月。术后3个月复查CT显示16例假腔内有血栓形成,13例真腔扩大,5例瘤腔内径缩小。术后半年CT显示9例假腔内完全血栓形成,6例部分血栓形成,2例轻微内漏者自愈,支架移位并迟发内漏1例。无死亡、瘤体破裂和截瘫发生。认为EVGE治疗S tan ford B型主动脉夹层微创、安全、有效,支架移植物的选择和准确定位是治疗成功的关键。     

用腔内隔绝术治疗B型主动脉夹层动脉瘤46例

目的评价用主动脉夹层动脉瘤腔内隔绝术治疗StanfordB型主动脉夹层动脉瘤的近、中期临床疗效。方法2002年5月至2006年9月,行主动脉腔内隔绝术治疗B型主动脉夹层46例。其中男36例,女10例;年龄62±18岁。46例均经股动脉切开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1~52个月,平均17±16个月,分析其临床特点及疗效。结果住院期间及随访30d内无患者死亡;发生主动脉腔内隔绝术后综合征11例;2例患者左锁骨下动脉被封闭;5例发生内漏,术后3个月时其中4例内漏自行封闭。随访3个月时,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。术后半年1例发生截瘫,原因不明。术后1年1例出现迟发性内漏;1例升主动脉发现夹层,未行外科手术。随访期间3例死亡,4年生存率89.3%。结论用主动脉夹层动脉瘤腔内隔绝术治疗B型主动脉夹层动脉瘤的近、中期疗效满意。     

StanfordB型胸主动脉夹层腔内隔绝术治疗的经验探讨

目的探讨主动脉腔内隔绝术在治疗Stanford B型主动脉夹层（aorticdissection，AD）的价值。方法回顾性分析我院2005—2008年行腔内隔绝术的17例Stanford B型主动脉夹层患者的资料。结果所有患者均完成带膜支架置入，术后1个月CTA随访14例假腔完全血栓化，夹层破裂死亡1例，出现新发破口2例，内漏1例。结论带膜支架腔内隔绝术治疗Stanford B型胸主动脉夹层是一种安全有效的方法，但术前破口定位。术中真腔确认及支架定位是手术成功的关键。     

主动脉瘤的外科治疗

目的总结主动脉瘤的外科治疗、腔内隔绝治疗的经验。方法回顾性分析1992年9月至2005年2月我院收治各类主动脉瘤患者46例的临床资料,男性38例,女性8例;平均年龄51.7岁;升主动脉瘤17例,胸主动脉瘤8例,腹主动脉瘤21例。手术治疗40例,其中Bentall手术10例,同期Bentall联合全弓替换1例,全弓替换2例,单纯升主动脉人工血管替换4例,胸主动脉瘤体切除人工血管置换3例,其中1例同时行双肾动脉搭桥术,胸主动脉瘤人工血管修补2例,1例行包裹术,腹主动脉瘤21例中行腋-股动脉人工血管搭桥2例,“Y”型人工血管置换7例,直型人工血管替换8例。腔内隔绝治疗6例;其中StanfordB型夹层动脉瘤2例,腹主动脉瘤4例。结果手术死亡1例,死亡率为2.5%,腔内隔绝治疗均成功。随访1个月至10年,有10例患者失访,随访期间1例死亡,总死亡率为4.3%。结论外科手术仍然是治疗主动脉瘤的一种十分有效和经济实用的主要方法。     

老年腹主动脉瘤患者的临床特点及围手术期处理

目的 探讨老年腹主动脉瘤患者的l临床特点及围手术期处理策略. 方法 回顾性分析我院24例60岁以上腹主动脉瘤手术患者的临床特点与围术期处理情况. 结果 24例患者平均年龄75.5岁;男女比例为5:1;病程2 d～15年,病程中位数为2.8个月;并存高血压17例、冠心病5例、2型糖尿病4例、慢性支气管炎3例、腔隙性脑梗死2例;腹主动脉瘤破裂患者3例;行带膜支架腔内隔绝术13例,腹主动脉瘤切除+人工血管置换术10例,带膜支架腔内隔绝术+右股动脉、右股深动脉内膜剥脱术+右股深动脉成形术+人工血管右股动脉一胭动脉搭桥术1例;术后并发症发生率为62.5%,病死率为20.8%. 结论 老年腹主动脉瘤患者多伴有冠心病、高血压、糖尿病、慢性支气管炎等老年慢性疾病;老年腹主动脉瘤手术是一类高风险手术,合理的术式选择与围手术期处理是老年腹主动脉瘤患者治疗成功的关键.     

覆膜支架腔内隔绝术治疗高龄胸腹主动脉瘤的疗效

目的：探讨主动脉腔内隔绝术治疗高龄患者胸腹动脉瘤的临床效果。方法：回顾性分析我院2004年2月至2011年7月25例实行覆膜支架腔内隔绝术的高龄胸腹主动脉瘤患者（年龄均≥65岁）的临床资料,总结手术效果,术后并发症和死亡率。结果：24例（96％）康复出院,术后并发症发生率24％（6／25）,病死率4％（1／25）,平均住院时间为（14．36±2．46）d,术后住院时间为（9．50±1．58）d。结论：覆膜支架腔内隔绝术可作为治疗高龄主动脉瘤首选方式,但须严格把握手术指征。     

心电门控主动脉计算机断层扫描血管造影在主动脉窦瘤诊断中的应用

目的 探讨心电门控主动脉计算机断层扫描血管造影（computed tomography angiography,CTA）在主动脉窦瘤诊断中的应用价值.方法 回顾性分析23例经手术证实的主动脉窦瘤患者的CTA图像,所有CTA图像均在心电门控条件下完成扫描.评估CTA图像上病灶的起源及大小、主动脉瘤是否破裂、冠状动脉位置及相关心血管发育异常的显示情况.结果 23例主动脉瘤患者中,感染性心内膜炎（获得性）6例（6/23,26.1％）,先天性17例（17/23,73.9％）.其中起源于右冠状动脉窦12例（52.2％）,左冠状动脉窦7例（30.4％）,无冠状动脉窦4例（17.4％）,CTA图像与手术吻合23例（100％）.窦瘤压迫右心室6例（26.1％）,右心室流出道3例（13.0％）,右心房4例（17.4％）,左心室6例（26.1％）,左心房4例（17.4％）,CTA图像与手术吻合23例（100％）.窦瘤破裂11例（47.8％）,未破12例（52.2％）,CTA图像与手术吻合22例（95.7％）.合并心血管畸形：主动脉二叶瓣5例（21.7％）,室间隔缺损3例（13.0％）,主动脉缩窄4例（17.4％）,主动脉弓褶曲2例（8.7％）.除1例瘘口、1例室间隔缺损CTA漏诊外,其余所见均与手术所见吻合.结论 心电门控主动脉CTA是诊断主动脉窦瘤及其并发症的有效方法,可提供准确的细节丰富的图像帮助诊断.     

Risk factors for descending aortic aneurysm formation in medium-term follow-up of patients with type A aortic dissection

BACKGROUND: After surgery to repair a type A aortic dissection, most late complications and mortality result from descending aorta-related problems. This study was performed to determine the risk factors leading to descending aortic aneurysm formation and late mortality in patients undergoing the type A aortic dissection operation. METHODS: The medical records of patients who survived the operation for type A aortic dissection between 1984 and 1998 were reviewed. There were 144 patients (95 men and 49 women), ranging in age from 24 to 78 years (mean age, 52 years). Most patients were acutely ill, 15 patients were in shock, and 54 patients had cardiac tamponade at the time of the surgical procedure. One hundred thirty-seven patients had ascending aortic replacement only, and of the other 6 patients 2 had hemiarch and 4 had total arch replacement using the elephant trunk technique. The aortic valve was replaced in 23 patients, resuspended in 100, and untouched in 21. Twenty-four risk factors were evaluated in statistical analyses for the prediction of descending aortic aneurysm formation and 3-year mortality. Risk factors were investigated using univariate and multiple logistic regression and survival analyses. RESULTS: The 3-year, 5-year, and 8-year cumulative survival rates were 96.2%, 89.1%, and 80.0%, respectively. The 3-year, 5-year, and 8-year cumulative survival rates, free from descending aortic aneurysm formation or descending aorta operation, were 74.7%, 58.6%, and 43.0%, respectively. Multivariate analysis confirmed that patent false lumen and initial descending aortic diameter were statistically significant risk factors for descending aortic aneurysm formation. CONCLUSIONS: The medium-term survival rate of patients who received operations for type A aortic dissection was satisfactory, despite the high incidence of descending aortic aneurysm formation. The intimal entry site over the aortic arch that was resected during the first operation could decrease the patency rate of a false lumen over the descending aorta. In the absence of a patent false lumen over the descending aorta, the chance of descending aortic aneurysm formation or operation is lessened, and the late survival rate is increased.     

老年髂动脉多发炎性动脉瘤的临床特点分析

目的了解髂动脉多发炎性腹主动脉瘤的临床特点,提高对本病诊断及药物治疗的认识。方法对1例发生于髂动脉的炎性腹主动脉瘤老年患者的临床资料进行分析,并复习有关文献。结果炎性腹主动脉瘤好发于70岁左右老年人,临床表现为突发腹痛或背痛,体重下降,C反应蛋白和红细胞沉降率升高,影像学检查可见动脉瘤壁增厚,炎症累及输尿管可引起肾盂积水,常规治疗需手术,早期经糖皮质激素及免疫抑制剂联合治疗可避免或推迟手术。结论突发严重腹痛的腹主动脉瘤患者,应尽早行影像学检查,发现动脉瘤壁增厚及肾盂积水支持本病诊断。早期糖皮质激素及免疫抑制剂治疗能显著缓解症状,并消除尿路梗阻。     

Rupture of a thoracic aortic aneurysm in a patient with hypertension, myocardial infarction, hyperlipidemia and operation for abdominal aortic aneurysm rupture after follow-up for 28 years

A Japanese man who died at age 86 had been followed since the age of 58, when he presented with hypertension of 150/95 mmHg. The patient remained socially active until he died suddenly of a ruptured thoracic aortic aneurysm, although he experienced angina pectoris in August 1974, and myocardial infarction was identified on electrocardiography in October 1974. He underwent operation for rectal cancer in 1987, and an abdominal aortic aneurysm 38mm in diameter was identified at that time. The patient underwent an operation for rupture of the abdominal aortic aneurysm in 1991. A thoracic aneurysm of 40 mm diameter was identified in 1995, and this expanded to 53 mm by 1997. Autopsy revealed a thoracic aortic aneurysm in the arch (8 x 5 x 5 cm) and descending aorta (7 x 7 x 8 cm). A large volume (2,080 ml) of bloody pleural fluid was present     

Surgical outcome of abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis

 Abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis presents several surgical difficulties due to tissue fragility, accelerated atherosclerosis, and calcification of the aorta. In addition to these surgical procedure-related problems, anemia, electrolyte abnormalities, bleeding tendency, and susceptibility to infection were also critical issues in perioperative management. The aim of this study was to examine the surgical outcome of abdominal aortic aneurysm repair in patients undergoing chronic hemodialysis. Between January 1988 and August 2001, six patients undergoing chronic hemodialysis underwent repair of an abdominal aortic aneurysm. There were five males and one female, and the mean age was 65 years. Two of the six patients had bilateral common iliac artery aneurysms in addition to the abdominal aortic aneurysm. At the time of abdominal aortic aneurysm repair, the duration of hemodialysis had ranged from 3 to 109 months, with a mean of 34 months. All patients underwent hemodialysis on the day prior to the abdominal aortic aneurysm repair operation. The first postoperative hemodialysis was scheduled to be performed on the day after operation or later. The mean duration of operation was 291 min. Blood transfusion was required in all patients. The first postoperative hemodialysis was performed between the first and third postoperative days. Postoperative complications were: ileus in one, and atrial fibrillation and blue toe syndrome just after operation in one. There was no hospital death. The follow-up period was 56 months. One patient died of lingual cancer at 102 months after operation. Five patients are alive. Abdominal aortic aneurysm repair can be done in patients on chronic hemodialysis with an acceptable early and long-term outcome. Received: March 12, 2002 / Accepted: September 21, 2002 Correspondence to Y. Umeda     

Surgical treatment of abdominal and thoracic aortic aneurysms in aged patients

A total of 378 patients with aortic aneurysm, consisting of 128 with abdominal aortic aneurysm (AAA) and 250 with thoracic aortic aneurysm (TAA), underwent operation in our institution during the past 20 years. Of these patients, 58 with AAA and 63 with TAA were 65 years old or over. Preoperative complications tended to be observed more frequently in the aged patients than in the younger, 'non-aged' patients. The early mortalities in the aged group were 5% for elective AAA operation, 40% for emergency AAA operation, 11% for elective TAA operation and 41% for emergency TAA operation. The 5-year survival rates in the aged group were 78.3 +/- 5.8% for AAA and 63.4 +/- 4.0% for TAA, which were not significantly different from those in the non-aged group, respectively. Postoperative complications tended to occur more frequently in the aged patients than in the non-aged patients both for AAA and TAA. The present data suggest that aggressive surgical treatment for aortic aneurysm in the aged is warranted unless other serious organ failure exists.