腔内技术二期隔绝Stanford B型主动脉夹层远端破口并重建腹主动脉内脏分支

目的观察腔内技术二期隔绝Stanford B型主动脉夹层(AD)远端破口并重建腹主动脉内脏分支的效果。方法回顾性分析12例接受体外预开窗技术二期手术隔绝Stanford B型AD远端破口并重建内脏分支患者资料,记录手术成功率及术后并发症,以主动脉CT血管造影(CTA)随访评估疗效。结果12例手术均成功,技术成功率100%。术后2例股动脉穿刺点血肿,3例肺部感染,均经保守治疗后好转。随访1~23个月,中位随访时间15个月,未见脑梗死、心肌梗死、截瘫、脏器缺血等严重并发症及死亡;复查主动脉CTA示AD破口隔绝良好,假腔内血栓形成,无内漏、新发破口及分支支架闭塞等。结论腔内技术可有效隔绝Stanford B型AD远端破口并重建腹主动脉内脏分支。

Endovascular technique for secondary closure of distal breach of aortic dissection and reconstruction of visceral branches of abdominal aorta

Objective To observe the effect of endovascular isolation of distal laceration of Stanford B type of aortic dissection (AD) and reconstruction of visceral arteries. Methods Data of 12 patients who underwent the second stage operation with extracorporeal pre fenestration technique to isolate the distal breach of Stanford B type of AD and to reconstruct visceral arteries were retrospectively analyzed. The success rate of operation was recorded, and postoperative aortic CT angiography (CTA) was used to follow up the therapeutic effect. Results Successful operation was performed in all 12 cases, and the technical success rate was 100%. After operation, hematoma at femoral artery puncture site and pulmonary infection were observed in 2 and 3 cases, respectively, which improved after conservative treatments. The patients were followed-up for 1-23 months, with a median follow-up time of 15 months. No severe complication, such as cerebral infarction, myocardial infarction, paraplegia, organ ischemia nor death occurred.Reexamination of aortic CTA showed that AD ruptures were well isolated and thrombus formed in the pseudolumen, without internal leakage, new rupture nor occlusion of the stents. Conclusion Endovascular technique could effectively isolate distal laceration of Stanford B type of AD and reconstruct visceral arteries.