中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

亚急性期 Stanford B 型主动脉夹层远端破口特点对胸主动脉腔内修复术后主动脉重塑的影响

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目的 探讨胸主动脉腔内修复术(Thoracic Endovascular Aortic Repair TEVAR)治疗亚急性期 Standford B 型主动脉夹层术中远端破口特点对术后主动脉重塑的影响。 方法 回顾性分析安徽省立医院 2011 年 7 月至 2015 年 4 月期间 B 型主动脉夹层 TEVAR 术中支架置入封闭近端破口后,远端破口仍有明显造影剂返流的 43 例,随访跟踪术后 3 月- 24 月主动脉真、假腔面积变化及血栓化情况,同时分析破口血流方向及假腔造影剂充填所需心搏数对主动脉假腔血栓形成的影响。 结果 所有支架都成功植入,假腔造影剂填充所需心搏数大于 2 个周期者术前和术后的真假腔面积变化及假腔形成率方面和小于 2 个周期者相比存在统计学差异(P<0.05),同时单因素分析显示远端破口血流溢入假腔方向对 TEVAR 对术后主动脉重塑无影响, 但术后血压控制不佳(≥140/90 mmHg)不利于术后主动脉重塑。 结论 TEVAR 术中支架置入封闭近端破口远端仍有破口且流速较快患者,在技术条件允许的情况下术中同期封闭流速较快的远端破口,术后需严格控制血压并密切随访。

Objective To investigate the effect of distal tears on postoperative aortic remodeling after Thoracic Endovascular Aortic Repair (TEVAR) for the patients with subacute stage of Stanford type B aortic dissection. Methods Forty three cases with Stanford type B aortic dissection, admitted in Anhui Provincial Hospital from July 2011 to April 2015, who underwent TEVAR to repair the proximal aortic entrance tear, after which the blood reflex from distal tears were still observed were analyzed retrospectively. According to the number of heart volume required to fill the two groups, group A (≤2 heart rate) group B (>2 heart rate), We then assessed the changes of the true and false lumen area and analyzed the effects of direction of blood flow and the number of heart rate to fill the false lumen on formation of false lumen thrombosis in the period of 3–24 months. Results All the stents were successful implanted. There was a statistically significant difference in lumen area between the two groups before and after surgery, and univariate analysis showed that the direction of distal rupture of blood flow into the false lumen had no effect on postoperative aortic remodeling (P<0.05), but postoperative hypertension (≥140/90 mmHg) slows down the formation of false lumen thrombosis. Conclusion Patients had entrance tear in the distal of aortic, still broken and faster flow after TEVAR stent-graft implantation in the proximal closed entrance tear. Blood pressure should be strictly controlled and close follow-up also needed, meanwhile, the distal entrances can be closed the same period if there is a faster flow from them.

关键词: Stanford B 型主动脉夹层; TEVAR; 远端破口; 重塑

Key words: Stanford type B aortic dissection; TEVAR; distal break; remodeling

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1. Akgul A, Gursoy M, Bakuy V, et al. Spontaneous triple coronary artery dissection. Ann Thorac Surg, 2013, 95(4): 1443-1445.
2. 任昊, 慈红波, 方青波, 等. 探讨 Stanford B 型主动脉夹层远端破口的分布特点及临床分型. 国际外科学杂志, 2014, 41(12): 824-826, 封3.
3. 张震, 杨绍军, 王家平. Stanford B 型主动脉夹层腔内隔绝术后主动脉重塑的特点及影响因素. 中国现代普通外科进展, 2009, (11): 957-960+978.
4. Nauta FJ, Trimarchi S, Kamman AV, et al. Update in the management of type B aortic dissection. Vasc Med, 2016, 21(3): 251-263.
5. Lombardi JV, Cambria RP, Nienaber CA, et al.Aortic remodeling after endovascular treatment ofcomplicated type B aortic dissection with the useof a composite device design. J Vasc Surg 2014;59(6):1544–54.
6. Melissano G, Bertoglio L, Rinaldi E, et al. Volume changes in aortic true and false lumen after the "PETTICOAT" procedure for type B aortic dissection. J Vasc Surg, 2012, 55(3): 641-651.
7. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
8. 中华医学会外科学分会血管外科学组. 主动脉夹层腔内治疗指南.
9. Han SM, Kuo EC, Woo K, et al. Remodeling of abdominal aortic branch perfusion after thoracic endovascular aortic repair for aortic dissections. J Vasc Surg, 2016, 64(4): 902-911.
10. Alfson DB, Ham SW. Type B Aortic Dissections: Current Guidelines for Treatment. Cardiol Clin, 2017, 35(3): 387-410.