摘要
目的评估Stanford B型症状性主动脉穿透性溃疡合并壁间血肿行血管腔内修复术的临床效果。方法选取2009年1月到2013年4月上海交通大学医学院附属仁济医院收治的Stanford B型急性主动脉综合征患者118例,并进行了血管腔内修复术(thoracic endovascular aortic repair,TEVAR)治疗。其中,28例患者通过计算机断层扫描血管成像(computer tomography angiography,CTA)诊断为B型主动脉穿透性溃疡(penetrating aortic ulcer,PAU)合并壁间血肿(aortic intramural hematoma,IMH),术后定期行CTA随访评估。所有28例患者的临床随访资料保存60个月。结果主动脉穿透性溃疡(PAU)合并壁间血肿(IMH)的患者在发病14 d后仍有可能继续进展。28例患者通过股动脉入路行TEVAR,成功率100%。1例患者置入了2个大血管支架。26例患者接受门诊随访,随访时间3~42个月(平均26个月),随访率达到92.8%,2例患者分别在术后第4个月和第16个月失随访。其余患者在随访期间无胸背疼痛。随访中2例左锁骨下动脉被支架覆盖的吸烟史患者在复吸时出现一过性眩晕。2例患者出现Ⅱ型内漏但不伴主动脉扩张,所有患者未再进行主动脉相关介入干预治疗。1例患者在术后42个月因车祸死亡。4例患者在随访期间接受过非心血管类手术。术后1年,2年和5年总体存活率分别为100%,100%和96.1%。结论症状性Stanford B型主动脉穿透性溃疡合并壁间血肿行血管腔内修复术微创、安全、有效,中远期随访结果满意,可能成为首选的治疗方案。术后严格随访,血压控制是保证远期效果的关键措施。长期结果有待进一步观察。
Objective To evaluate the clinical effect of endovascular repair for Stanford type B symptomatic aortic penetrating ulcer complicated with intramural hematoma.Methods A total of 118 patients with Stanford type B acute aortic syndrome who were admitted to Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from January 2009 to April 2013 were selected and underwent thoracic endovascular aortic repair(TEVAR).Among them,28 patients were diagnosed as type B aortic penetrating ulcer(PAU)with aortic intramural hematoma(IMH)by computer tomography angiography(CTA).The follow-up assessment was conducted by CTA.The clinical follow-up data of all 28 patients were kept for 60 months.Results The patients with aortic penetrating ulcer(PAU)complicated with intramural hematoma(IMH)still progressed 14 days later after the onset.28 patients underwent TEVAR via the femoral artery approach with a success rate of 100%.2 large vessel stents were implanted in one patient.26 patients received outpatient follow-up;the follow-up time was 3 to 42 months(average 26 months)and the follow-up rate was 92.8%.The remaining patients had no chest and back pain during follow-up.During follow-up,2 patients with smoking history whose left subclavian artery was covered by stent developed transient vertigo during relapse.2 patients developed typeⅡendoleak without aortic dilatation;and all the patients did not undergo aortic-related intervention.1 patient died in a car accident in 42 months after surgery.4 patients underwent non-cardiovascular surgery during the follow-up period.The 1,2 and 5-year overall survival rates were 100%,100%and 96.1%,respectively.Conclusion Endovascular repair is minimally invasive,safe and effective for symptomatic Stanford type B aortic penetrating ulcer complicated with intramural hematoma.The results of medium and long-term follow-up are satisfactory.It may become the first choice for the treatment.Strict follow-up after the surgery and blood pressure control are the key measures to ensure the
作者
刘冀东
杨文钢
顾剑民
薛松
刘叶
LIU Ji-dong;YANG Wen-gang;GU Jian-min;XUE Song;LIU Ye(Department of Cardiovascular Surgery,Ren ji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)
出处
《中国心血管病研究》
CAS
2022年第11期993-997,共5页
Chinese Journal of Cardiovascular Research
基金
上海交通大学医学院附属仁济医院临床科研创新培育基金项目(PYII20-06)
浦东新区卫健委卫生科技项目(PW2015D-2)。
