摘要
目的探讨血管腔内治疗 DeBakey Ⅰ型主动脉夹层动脉瘤的方法。方法对7例DeBakey Ⅰ型主动脉夹层动脉瘤进行血管腔内治疗。7例均行磁共振血管造影、CT 和动脉造影检查确诊。内膜撕裂口均位于升主动脉,距冠状动脉开口2.5～6.0 cm,距右头臂干开口0.5～4.0 cm。2例通过左颈总动脉置入带膜支架,术前行左锁骨下动脉-左颈总动脉间内转流术以保证左颈总动脉血供。5例通过右股总动脉置入带膜支架,其中2例先行左锁骨下动脉-左颈总动脉-右颈总动脉人工血管旁路术。结果全组均手术成功。3例第1枚支架释放后仍有较多内漏,即再放入第2枚支架,交错重叠于第1枚支架内面而成功封闭撕裂口,消灭内漏。除1例术后1个月因急性上消化道大出血死亡外,其余6例存活。6例的假腔均有血栓形成,无内漏,无新的夹层动脉瘤形成。结论 DeBakeyⅠ型主动脉夹层动脉瘤的血管腔内治疗是可行、微创和有效的。病例选择应注意撕裂口距冠状动脉开口的距离。
Objective To study endovascular treatment of DeBakey type Ⅰ aortic dissecting aneurysm. Methods Seven patients with DeBakey Ⅰ aortic dissecting aneurysms were treated. Diagnoses were confirmed by MRA, CT and angiography. The intimal tear entry was in the ascending aorta, 2. 5 - 6. 0 cm from the ostia of the coronary arteries, and 0.5 - 4.0 cm from the brachiocephalic trunk opening. Endovascular stent-grafts were deployed via a left common carotid artery （LCCA） approach in 2 cases and right femoral artery （RFA） approach in 5 cases. Prior to treatment, a left subclavicular artery （LSA） -LCCA shunt was established to ensure blood supply to the LCCA during surgery in 2 cases via LCCA approach, and a LSA-LCCA-right common carotid artery （RCCA） synthetic bypass was established to ensure blood supply to the brain in 2 cases in RFA approach. Results The operative success rate was 100%. In 3 cases, endoleak persisted after the first stent was placed, but this was eliminated by placement of a second stent. All patients survived except one who died of acute massive hemorrhage from the upper gastrointestinal tract one month postoperatively. The false lumen in all 6 cases became thrombolized and no endoleak or new aortic dissecting aneurysms developed. Conclusions Endovascular treatment of DeBakey type Ⅰ aortic dissecting aneurysm is feasible, minimally invasive, and effective. Case selection depends on the distance of the coronary artery ostia from the tear entry.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第3期168-171,共4页
Chinese Journal of Surgery
