刘浩,黄小勇,吴文辉,郭曦,刘光锐,韩晓峰,黄连军

• 1:首都医科大学附属北京安贞医院介入诊疗科

摘要(Abstract)：

目的探讨血肿累及主动脉弓部对复杂型B型主动脉壁间血肿胸主动脉腔内修复术的影响。方法回顾性分析自2011年2月至2015年6月首都医科大学附属北京安贞医院连续收治复杂型B型主动脉壁间血肿69例,其中男58例,女11例,平均年龄(58.1±8.9)岁,所有患者均在局麻强化下行胸主动脉腔内修复术。A组为血肿累及左锁骨下动脉的主动脉壁间血肿患者,B组为血肿未累及弓部的主动脉壁间血肿患者。比较两组患者围术期及近中期并发症发生率。结果 A组2例患者于术中出现支架相关性新发破口造成A型主动脉夹层,急转外科手术,1例患者于术后1个月复查发现支架相关新发破口,转外科手术。B组1例患者于术后1年复查出现支架相关新发破口,后保守治疗失访,1例于围术期发生截瘫。结论 B型主动脉壁间血肿弓部受累尚不能作为腔内治疗围术期支架相关性新发破口的危险因素,但需进一步研究证明。同时术后严格控制血压对预防近中期支架相关并发症至关重要。

关键词(KeyWords)： 弓部血肿;复杂型B型主动脉壁间血肿;腔内治疗;并发症

Abstract:

Keywords:

基金项目(Foundation): 基金项目:主动脉夹层脏器缺血评价及临床处理方法优选(首发2014-1-1052);; 国人主动脉夹层规范化诊疗及关键技术的研究(201402009)

作者(Author): 刘浩,黄小勇,吴文辉,郭曦,刘光锐,韩晓峰,黄连军

参考文献(References)：

• [1]Nathan DP,Xu C,Gorman JH 3rd,et al.Pathogenesis of ac ute aortic dissection:a finite element stress analysis.Ann Thorac Surg,2011,91(2):458-463.
• [2]Monnin-Bares V,Thony F,Rodiere M,et al.Endovascular stent-graft management of aortic intramural hematomas.J Vasc Interv Radiol,2009,20(6):713-21.
• [3]Yoon-Jung Choi,Jang-Won Son,Sang-Hee Lee,et al.Treatment patterns and their outcome of acute aortic intramural hematoma in real world:multicenter registry for acute aortic intramural hematoma.BMC Cardiovascular Disorders,2014,14:103.
• [4]Neuhauser B,Greiner A,Jaschke W,et al.Serious complicatio ns following endovascular thoracic aortic stent-graft repair for type B dissection.Eur J Cardiothorac Surg,2008,33(1):58-63.
• [5]Erbel R,Aboyans V,Boileau C,et al.2014 ESC Guidelines on the diagnosis and treatment of aortic diseases:document covering acute and chronic aortic disease of thoracic and abdominal aortic of the adults,The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology(ESC).Eur Heart J,2014,35(41):2873-2926.
• [6]Eggebrecht H,Plicht B,Kahlert P,et al.Intramural hematoma and penetrating ulcers:indications to endovascular treatment.Eur J Vasc Endovasc Surg,2009,38(6):659-665.
• [7]Evangelista A,Mukherjee D,Metha RH,et al.Acute intramural hematoma of the aorta:a mystery in evolution.Cirtulation,2005,111(8):1063-1070.
• [8]Nishigami k,Tsuchiya T,Shono H,et al.Disappearance of aortic intramural hematoma and its significance to prognosis.Circulation,2000,102(19 Suppl 3):Ⅲ243-247.
• [9]Title SL,Lynch RJ,Cole PE,et al.Midterm follows-up of penetrating ulcer and intramural hematoma of the aorta.J Thorac Cardiovasc Surg,2002,123(6):1051-1059.
• [10]Vilacosta I,San Román JA,Ferreirós J,et al.Natural history and serial morphology of aortic intramural hematoma:a novel variant of aortic dissection.Am Heart J,1997,134(3):495-507.
• [11]Ishida M,Kato N,Hirano T,et,al.Endovascular stent-graft treatment of thoracic aortic aneurysms:short-to midterm results.J Vasc Interv Radiol,2004,15(4):361-367.
• [12]Kitai T,Kaji S,Yamamuro A,et al.Impact of new development of ulcer-like projection on clinical outcome in patients with type Baortic dissection with closed and thrombosed false lumen.Circulation,2010,122(11 Suppl):S74-80
• [13]Sueyoshi E,Matsuoka Y,Imada T,et al.New development of an ulcerlike projection in aortic intramural hematoma:CT evolution.Radiology,2002,224(2):536-541.
• [14]Ganaha F,Miller DC,Sugimoto K,et al.Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer:a clinical and radiological analysis.Circulation,2002,106(3):342-348.
• [15]Lavingia KS,Ahanchi SS,Redlinger RE,et al.Aortic remodeling after thoracic endovascular aortic repair for intramural hematoma.J Vasc Surg,2014,60(4):929-935;discussion 935-936.
• [16]Thrumurthy SG,Karthikesalingam A,Patterson BO,et al.ASystematic Review of Mid-term Outcomes of Thoracic Endovascular Repair(TEVAR)of Chronic Type B Aortic Dissection.Eur J Vasc Endovasc Surg,2011,42(5):632-647.