摘要
目的探讨胸主动脉夹层腔内治疗时真假腔的识别方法及效果。方法抽取安阳市人民医院2018年1月至2021年6月收治的90例胸主动脉夹层患者,所有患者术前均接受CT血管造影(CTA)检查评估胸主动脉夹层形态学情况。所有患者均在数字减影血管造影(DSA)监视下完成腔内治疗。术中采取多种方法识别真假腔,包括左肱动脉穿刺插管造影法、髂或股动脉插管造影法(如夹层裂口切线位造影法、导管沿途冒烟法)等。结果90例胸主动脉夹层患者行腔内治疗时,采取左肱动脉穿刺插管造影法66例,髂或股动脉插管造影法24例。左前斜45°造影结果显示,68例夹层假腔位于降主动脉外侧,而22例假腔位于降主动脉内侧或与真腔重叠;腹主动脉段夹层真假腔位置复杂,假腔于螺旋下降过程中可位于真腔任何一侧,其中6例腹主动脉存有2个及以上假腔;90例胸主动脉夹层采取左肱动脉穿刺插管造影法、髂或股动脉插管造影法和全弓降主动脉造影—胸降主动脉留置猪尾导管法识别真假腔,最终全部成功定位真腔,且顺利完成腔内治疗,夹层远端真腔血流恢复率为100%。结论对于胸主动脉夹层患者,术前行CTA检查做好评估,术中在DSA监视下,予以左肱动脉穿刺插管造影法、髂或股动脉插管造影法等识别真假腔,可准确判断,从而避免误判及其所致并发症发生,提高了腔内治疗的安全性。
Objective To investigate the method and effect of identifying true and false lumens during endovascular treatment of thoracic aortic dissection.Methods Ninety patients with thoracic aortic dissection who were admitted to Anyang People’s Hospital from January 2018 to June 2021 were selected for research.All patients underwent computed tomography angiography(CTA)examination before surgery to evaluate the morphology of thoracic aortic dissection,endoluminal treatment was performed under the monitoring of digital subtraction angiography(DSA)on all patients.And multiple methods were used to identify true and false lumens during the operation,including left brachial artery puncture intubation angiography,iliac or femoral artery intubation angiography(such as tangential angiography of dissection cracks,smoke along the way of the catheter).Results In the treatment of 90 patients with thoracic aortic dissection,66 patients underwent left brachial artery puncture intubation angiography,and 24 patients underwent iliac or femoral artery intubation angiography.The results of left anterior oblique 45°angiography showed that 68 cases dissection false lumen located on the lateral descending aorta,while 22 cases false lumen located on the inner side of the descending aorta or overlapped with the true lumen.Locations of true and false lumen in abdominal aorta were complex,and false lumen could spirally fall to either side of true lumen.Six cases had 2 or more false lumens in abdominal aorta.Ninety cases of thoracic aortic dissection were detected by left brachial artery puncture intubation angiography,iliac or femoral artery intubation angiography,and total descending aorta angiography-the indwelling pigtail catheter method to identify the true and false lumen.Finally,the true lumen was successfully located,and the endoluminal treatment was successfully completed.The blood flow recovery rate of the true lumen at the distal end of the dissection was 100%.Conclusions For patients with thoracic aortic dissection,preoperative CTA e
作者
韩越博
郑诒璋
史芳涛
王宏涛
王俊生
Han Yuebo;Zheng Yizhang;Shi Fangtao;Wang Hongtao;Wang Junsheng(Department of Cardiac Surgery,Anyang People’s Hospital,Anyang 455000,China)
出处
《中国实用医刊》
2022年第18期57-60,共4页
Chinese Journal of Practical Medicine
关键词
主动脉夹层
腔内治疗
真假腔
Aortic dissection
Endoluminal therapy
True and false lumen
