摘要
目的探讨主动脉夹层支架误值入假腔的判断及再次腔内修复技术的可行性和有效性。方法回顾性分析我院2013年1月至2017年12月,经腔内修复技术治疗的主动脉夹层手术支架误植入假腔5例患者的临床及影像资料。其中男3例,女2例,年龄28~52岁,2例为急性期StanfordA型夹层行主动脉置换加支架象鼻技术,术后当日患者出现脏器缺血及内环境紊乱,经急诊主动脉CTA证实支架植入假腔;2例为亚急性期StanfordB型夹层行胸主动脉腔内修复术,覆膜支架植入假腔;1例因妊娠高血压急性StanfordB型夹层。患者应用穿刺内膜片破膜技术或远端继发破口路径再次植入新的覆膜支架,桥接原有支架及远端真腔,矫正主动脉血流返回真腔。结果5例患者成功完成覆膜支架腔内修复术矫正主动脉血流回真腔。手术时间45~120min,术中出血量50~100ml。使用5枚长度160mm、锥度6mm的覆膜支架,1枚长度120mm、锥度10mm支架;术后7d后出院,30d复查无截瘫、脏器缺血及其他相关并发症;复查主动脉CTA显示支架位置良好,各分支血管通畅,无内漏表现。结论主动脉夹层一期手术支架植入假腔为少见的危重并发症,主动脉CTA可以快速、准确识别该并发症。腔内修复术能迅速、有效地将血流矫正回真腔,可以作为急诊处理的首选方法。
Objective To discuss the discovery of stent graft mis-deployed into false lumen during aortic dissection treatment and re-deployment. Methods Retrospective analysis of the data of deployment of the stent-graft into the false lumen in the initial treatment of aortic dissection between January 2013 to December 2017. Of the five cases, there were three males and two females, range from 28 to 52 year old. Two patients, suffered from acute Stanford type A aortic dissection, with aortic surgical replacement and circulatory elephant trunk technique, displayed the visceral ischemia and internal environment disorder post-operatively. An emergency CT angiography showed that the deployed stent-graft was in the false lumen. Another two cases with sub-acute Stanford type B aortic dissection underwent TEVAR. The stent-grafts were put in the false lumen intra-operatively, one patient with pregnancy-induced hypertension suffered from acute Stanford type B aortic dissection. An emergency endovascular repair was set under general anesthesia to deal with this problem. New stent-graft was utilized to correct the blood flow into true lumen via flap fenestration or secondary intimal tear. Results The successful rate of this operation was 100%. Time of surgery spanned from 45 minutes to 120 minutes, and blood loss was estimated to be from 50 ml to 100 ml. Five stent grafts were placed with 160 mm length and 6 mm taper and one was 120 mm length and 10 mm taper. Patients were observed in ICU for three days and discharged from hospital after seven days. No complications such as paraplegia, visceral ischemia, etc occurred. Postoperative aortic CTA one month later showed no complications, such as endoleak, etc. The stents were in ideal position, with fluent blood flow of aorta and major visceral artery. Conclusions Deployment of the stent-graft in the false lumen is a rare and critical complication in the treatment of aortic dissection. In addition to clinical manifestations and laboratory tests, aortic CTA could identify this complication
作者
黄小勇
濮欣
庄媛
里程楠
白涛
黄连军
Huang Xiaoyong;Pu Xin;Zhuang Yuan;Li Chengnan;Bai Tao;Huang Lianjun(Interventional Department,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2018年第12期947-951,共5页
Chinese Journal of Radiology
基金
国家自然科学基金(81570421).
