高危胸降主动脉瘤腔内修复治疗Clinical outcomes of endovascular repair of descending thoracic aortic aneurysm in high-risk patients
施德兵,符伟国,王玉琦,陈斌,郭大乔,徐欣,蒋俊豪,杨珏,史振宇,董智慧,竺挺,李炜淼
摘要(Abstract)：
目的总结高危患者行胸降主动脉瘤(descending thoracic aortic aneurysm,DTAA)腔内修复治疗(endovascular aneurysm repair,EVAR)的经验。方法回顾分析2001年1月至2007年7月我科24例高危DTAA患者行EVAR诊治经过、结果和并发症。所有患者因动脉瘤部位、破裂、高龄或严重合并症而不适合行开放手术。EVAR术后1个月、3个月、6个月、12个月和每年行螺旋CT血管造影、三维重建随访。结果所有患者均获技术成功(100%)。围手术期死亡2例(8.3%),分别死于多系统器官功能衰竭和急性心肌梗死。2例(8.3%)术后发生严重并发症(1例缺血性脑卒中和1例急性肾功能不全)。11例(46%)术后即时造影显示近端Ⅰ型内漏,其中3例内漏量大,行球囊扩张后内漏消失;另8例随访观察。19例患者获随访,随访时间为1~60个月(平均18.6±4.2个月)。1例患者术后4年发生支架型人工血管移位并发Ⅰ型内漏,1例术后2年出现迟发性Ⅲ型内漏,均成功行EVAR。1例死于结肠癌。其余患者术后3个月CT证实瘤腔内完全血栓形成,无支架移位和内漏。随访期间动脉瘤最大直径缩小0~18 mm(平均6.3±3.1 mm),4例辅助性动脉旁路在随访期间人工血管均通畅。结论EVAR治疗高危DTAA早期死亡率和并发症发生率尚可接受,对某些病例可能是首选治疗方法。
关键词(KeyWords)： 主动脉瘤,胸;血管成形术;血管假体植入;危重病人医疗
基金项目(Foundation):
作者(Author): 施德兵,符伟国,王玉琦,陈斌,郭大乔,徐欣,蒋俊豪,杨珏,史振宇,董智慧,竺挺,李炜淼
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