中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

限制性裸支架在急性 Standford A 型主动脉夹层中的应用

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目的 对限制性裸支架释放于急性 Standford A 型主动脉夹层支架象鼻远端的应用观察。 方法 回顾性分析 2016 年 11 月到 2018 年 2 月我院大血管中心对急性 Standford A 型主动脉夹层需要做主动脉弓置换+支架象鼻手术同时行限制性裸支架置入 22 例患者的临床资料,其中男 19 例、女 3 例,平均年龄 34~68(49.72±8.05)岁。将裸支架释放于胸降主动脉内,再将支架象鼻置于裸支架内,出院前复查主动脉血管 CT 造影(CTA),观察支架位置及并发症情况。 结果 1 例患者裸支架置入时阻力较大,自行脱出而放弃置入;余 21 例患者成功完成限制性裸支架置入,术后 1 例患者住院期间因“大面积脑梗”死亡。1 例截瘫。生存并成功置入裸支架的 20 例患者均定期随访,随访期内无卒中、死亡。计算机体层扫描血管成像检查支架形态、位置良好,无移位及Ⅲ型内漏发生,未见支架远端新发破口。 结论 作为支架象鼻手术的辅助治疗手段,限制性裸支架的使用能减少支架源性新发破口的发生且可以明显扩张支架象鼻远端血管真腔口径,主动脉重塑效果良好。

Objective To observe the effect of restrictive bare stent released on the distal end of the trunk of Standford type A aortic dissection. Methods Retrospective analysis from November 2016 to February 2018, 22 patients with Standford type A aortic dissection requiring aortic arch replacement and trunk surgery were selected for restrictive bare stent placement. Among them, there were 19 males and 3 females, aged 34–68 (49.72±8.05) years. The bare stent was released in the descending thoracic aorta, and the frozen elephant trunk was placed in the bare stent. The Aortic CTA was reviewed before discharge and the stent position and complications were observed. Results One patient had a greater resistance when implanted with bare stents, and self-relieved to give up. The remaining 21 patients successfully completed restrictive bare stent placement. One patient died of " large-area cerebral infarction” after surgery. A patient of paraplegia. Twenty patients who survived and successfully implanted bare stents were followed up at regular intervals. No stroke or death occurred during the follow-up period. The computerized tomography angiography showed good stent morphology and position, no displacement, and type Ⅲ endoleak. No new distal end of the stent was seen. Conclusion As an adjunct to frozen elephant trunk, the use of restrictive bare stents can reduce the possibility of a recurrence of a distal stent fracture and the restrictive bare stent can significantly expand the narrowest segment and true lumen caliber near the endoluminal graft. Arterial remodeling works well.

关键词: StandfordA 型主动脉夹层; 象鼻支架; 裸支架; 疗效

Key words: Standford type A aortic dissection; stented elephant trunk; restrictive bare stent; curative effect

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