[1]刘光锐,郭 曦,李铁铮,等.同期胸主动脉腔内修复与肾动脉覆膜支架植入治疗Stanford B型主动脉夹层伴近肾动脉再破口15例[J].介入放射学杂志,2018,27(08):721-724.
　LIU Guangrui,GUO Xi,LI Tiezheng,et al.Simultaneous performance of TEVAR and renal artery covered stent implantation for Stanford type B aortic dissection complicated by large reentry adjacent to renal artery[J].journal interventional radiology,2018,27(08):721-724.
点击复制

同期胸主动脉腔内修复与肾动脉覆膜支架植入治疗Stanford B型主动脉夹层伴近肾动脉再破口15例()

PDF下载中关闭

分享到：

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
27
期数:
2018年08期
页码:
721-724
栏目:
心脏介入
出版日期:
2018-08-25

文章信息/Info

Title:
Simultaneous performance of TEVAR and renal artery covered stent implantation for Stanford type B aortic dissection complicated by large reentry adjacent to renal artery
作者:
刘光锐;  郭 曦;  李铁铮;  韩晓峰;  薛玉国;  黄连军
Author(s):
LIU Guangrui;  GUO Xi;  LI Tiezheng;  HAN Xiaofeng;  XUE Yuguo;  HUANG Lianjun
Department of Interventional Diagnosis and Treatment， Affiliated Beijing Anzhen Hospital， Capital Medical University， Beijing 100029， China
关键词:
【关键词】 主动脉夹层;  再破口;  肾动脉;  覆膜支架
文献标志码:
A
摘要:
【摘要】 目的 评价同期胸主动脉腔内修复术（TEVAR）与肾动脉覆膜支架植入术治疗Stanford B型主动脉夹层（AD）伴近肾动脉较大再破口的中期疗效。方法 2014年1月至2016年1月间共对15例Stanford B型AD患者行同期TEVAR与肾动脉覆膜支架植入术。其中男12例，女3例；年龄35～67岁，平均（48.93±6.42）岁。术前完善胸主动脉CTA检查。局部麻醉联合静脉强化麻醉下行经股动脉置管TEVAR术，隔绝近端原发破口，同期行肾动脉覆膜支架移植术隔绝近肾动脉水平较大再破口。收集分析影像学和实验室检查资料，出院后随访1～3年，评估治疗效果。结果 所有患者均顺利完成手术，成功率为100%。15例共植入主动脉覆膜支架18枚，支架近端直径28～42 mm，远端直径24～42 mm，长度150～230 mm；植入肾动脉覆膜支架15枚（右肾动脉9例，左肾动脉6例）， 支架直径5～8 mm，长度2.5～5 mm，其中3例予球囊后扩张。术前平均血清肌酐值为（82.41±12.32） mmol/L，术后12个月为（75.88±11.36） mmol/L。随访显示3例假腔完全重塑吸收，5例完全血栓化，7例部分血栓化，肾动脉覆膜支架通畅率100%。结论同期TEVAR与肾动脉覆膜支架植入术治疗B型AD伴近肾动脉较大再破口患者安全有效，部分患者可达到一期治愈。

参考文献/References:

［1］ Qin YL， Wang F， Li TX， et al. Endovascular repair compared with medical management of patients with uncomplicated type B acute aortic dissection［J］. J Am Coll Cardiol， 2016， 67： 2835- 2842.
［2］ Dake MD， Kato N， Mitchell RS， et al. Endovascular stent- graft placement for the treatment of acute aortic dissection［J］. N Engl J Med， 1999， 340： 1546- 1552.
［3］ Hiratzka LF， Bakris GL， Beckman JA， et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines， American Association for Thoracic Surgery， American College of Radiology， American Stroke Association， Society of Cardiovascular Anesthesiologists， Society for Cardiovascular Angiography and Interventions， Society of Interventional Radiology， Society of Thoracic Surgeons， and Society for Vascular Medicine ［J］. J Am Coll Cardiol， 2010， 55： e27- e129.
［4］ White RA， Miller DC， Criado FJ， et al. Report on the results of thoracic endovascular aortic repair for acute， complicated， type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee［J］. J Vasc Surg， 2011， 53： 1082- 1090.
［5］ Manning BJ， Dias N， Manno M， et al. Endovascular treatment of acute complicated type B dissection： morphological changes at midterm follow- up［J］. J Endovasc Ther， 2009， 16： 466- 474.
［6］ 章思梦， 陆清声， 景在平． Standford B型主动脉夹层腔内修复术后主动脉重塑效果［J］． 介入放射学杂志， 2016， 25： 302- 307．
［7］ 韩 磊， 万珊杉， 王家平， 等． 不同期Stanford B型胸主动脉夹层腔内修复术后疗效及主动脉重塑临床研究［J］． 介入放射学杂志， 2016， 25： 958- 961．
［8］ Tsai TT， Schlicht MS， Khanafer K， et al. Tear size and location impacts false lumen pressure in an ex vivo model of chronic type B aortic dissection［J］. J Vasc Surg， 2008， 47： 844- 851.
［9］ Kamman AV， Brunkwall J， Verhoeven EL， et al. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment （ADSORB） database［J］. J Vasc Surg， 2017， 65： 964- 971.
［10］ Behrendt P， Do D， Baumgartner I， et al. Renal artery stenting following acute aortic dissection： implantation and follow- up［J］. Vasa， 2000， 29： 138- 140.
［11］ Simring D， Raja J， Morgan- Rowe L， et al. Placement of a branched stent graft into the false lumen of a chronic type B aortic dissection［J］. J Vasc Surg， 2011， 54： 1784- 1787.
［12］ Verhoeven EL， Paraskevas KI， Oikonomou K， et al. Fenestrated and branched stent- grafts to treat post- dissection chronic aortic aneurysms after initial treatment in the acute setting［J］. J Endovasc Ther， 2012， 19： 343- 349.
［13］ Berger L， Palcau L， Gouicem D， et al. Persistent type B aortic dissection treatment by renal artery reentry stent grafting as an alternative to open surgery［J］. Ann Vasc Surg， 2013， 27： 498.e5- 498.e8.

相似文献/References:

[1]王茂华,金 星,吴学君. 腔内修复术成功救治外伤性主动脉夹层伴截瘫一例[J].介入放射学杂志,2012,(12):1059.
　WANG Mao? hua,JIN Xing,WU Xue? jun.. The traumatic aortic dissection accompanied by paraplegia successfully treated with endovascular repair： report of one case[J].journal interventional radiology,2012,(08):1059.
[2]张晔青,李晓强.Stanford A型夹层并发右下肢及肠缺血误诊一例[J].介入放射学杂志,2014,(01):11.
　ZHANG Ye? qing,LI Xiao? qiang.. Misdiagnosis of Stanford type A aortic dissection complicated by ischemia of right lower limb and intestine： report of one case[J].journal interventional radiology,2014,(08):11.
[3]戚光祖,邴学华. 腔内修复联合动脉旁路术治疗近端锚定区不足的主动脉夹层[J].介入放射学杂志,2013,(09):727.
　QI Guang? zu,BING Xue? hua.. Endovascular repair combined with arterial bypass for the treatment of aortic dissection with insufficient proximal anchorage zone[J].journal interventional radiology,2013,(08):727.
[4]王志伟,王家祥,李 震,等. 无钙化B型主动脉壁间血肿的治疗[J].介入放射学杂志,2014,(03):210.
　WANG Zhi? wei,WANG Jia? xiang,LI Zhen,et al. Conservative treatment of type B aortic intramural hematoma with no calcification[J].journal interventional radiology,2014,(08):210.
[5]侯钦茂,冯家烜,张荣杰,等.Stanford B型主动脉夹层腔内介入治疗时机对预后的影响 [J].介入放射学杂志,2018,27(04):310.
　HOU Qinmao,FENG Jiaxuan,ZHANG Rongjie,et al.The effect of timing of TEVAR on the prognosis of patients with Stanford type B aortic dissection [J].journal interventional radiology,2018,27(08):310.
[6]边 云,王 莉,陆建平,等.640层容积CT对Stanford B型主动脉夹层腔内隔绝术后随访的应用价值[J].介入放射学杂志,2012,(11):912.
[7]周静文,陈德基,林少芒,等.左锁骨下动脉“烟囱”技术在胸主动脉夹层腔内修复术中的应用[J].介入放射学杂志,2015,(08):668.
　ZHOU Jing- wen,CHEN De- ji,LIN Shao- mang,et al.The application of “chimney” technique of left subclavian artery in performing endovascular repair procedure for Stanford type B aortic dissection[J].journal interventional radiology,2015,(08):668.
[8]保广鹤,李焕祥,马彦寿.裸支架烟囱技术治疗主动脉夹层伴左颈总动脉破口[J].介入放射学杂志,2015,(09):767.
　BAO Guang- he,LI Huan- xiang,MA Yan- shou.The application of bare- stent“chimney” technique in treating aortic dissection complicated by left common carotid rupture[J].journal interventional radiology,2015,(08):767.
[9]吕俊远,王 雷,杨春卿,等.中心线法测量B型主动脉夹层锚定区的初步研究 [J].介入放射学杂志,2015,(10):857.
　LV Jun- yuan,WANG Lei,YANG Chun- qing,et al.Centerline analysis for the measurement of aortic diameter at proximal landing zone in type B aortic dissection： a preliminary study[J].journal interventional radiology,2015,(08):857.
[10]逯党辉,翟水亭,李天晓,等.复合手术治疗Stanford B型胸主动脉夹层 [J].介入放射学杂志,2015,(10):897.
　LU Dang-hui,ZHAI Shui-ting,LI Tian-xiao,et al.Hybrid operation for the treatment of Stanford type B aortic dissection[J].journal interventional radiology,2015,(08):897.

备注/Memo

备注/Memo:
（收稿日期：２０１7-０7-０6）
（本文编辑：边 佶）
更新日期/Last Update: 2018-08-17