Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层临床诊治分析

发布时间：2019-02-20 21:54

【摘要】：目的探讨Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层的机制与诊治。方法回顾性分析自2002年4月至2014年12月沈阳军区总医院心血管内科收治的Stanford B型主动脉夹层中行主动脉腔内修复术患者随访期间发生覆膜支架远端再发夹层的临床特点,同时分析患者发生再次主动脉夹层的影响因素以及诊疗方案。结果 10例主动脉覆膜支架远端再发夹层,7例应用直筒(近端与远端直径无落差)覆膜支架,3例应用近端与远端直径落差均为2 mm的覆膜支架,支架长度均在150 mm以内。9例再次行腔内修复术,1例患者拒绝再次行主动脉腔内修复术,行药物保守治疗。其中1例患者2次出现支架远端再发夹层,2次均行主动脉腔内修复术。所有手术患者均手术成功,无并发症,随访期间2例患者出现脑卒中,分别发生于再次腔内修复术后1个月、6个月,无截瘫和死亡事件。结论注重支架长度及直径落差选择对预防动脉夹层腔内修复术后覆膜支架远端再发夹层有临床意义。再次介入治疗可有效治疗Stanford B型主动脉夹层腔内修复术后覆膜支架远端再发夹层,再次治疗并发症少,安全性高。
[Abstract]:Objective to investigate the mechanism, diagnosis and treatment of Stanford B aortic dissection after endovascular repair. Methods from April 2002 to December 2014, the clinical features of Stanford B aortic dissection treated in Department of Cardiovascular Medicine of Shenyang military region General Hospital were retrospectively analyzed. At the same time, the influencing factors and the diagnosis and treatment plan of the patients with recurrent aortic dissection were analyzed. Results there were 10 cases of distal dissection of aortic stent, 7 cases were treated with straight tube (no drop between proximal and distal diameters), and 3 cases were stents with the drop of proximal and distal diameters of 2 mm. The length of stent was less than 150 mm. 9 cases were treated with endovascular repair again, 1 case refused to perform aortic endovascular repair again, and 1 case received conservative drug therapy. One patient had recurrent distal stent dissection twice, and two times endovascular repair was performed. All the patients were successfully operated without complications. During the follow-up period, 2 patients suffered from stroke, which occurred in 1 month and 6 months after re-intracavitary repair, respectively. There were no paraplegia and death events. Conclusion it is of clinical significance to focus on the choice of stent length and diameter difference to prevent the distal recanalization of stent after endovascular repair of arterial dissection. The second interventional therapy can effectively treat Stanford type B aortic dissection after endovascular repair.
【作者单位】：沈阳军区总医院全军心血管病研究所心内科;
【基金】：辽宁省科技计划项目(2012225009)
【分类号】：R654.3

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