【摘要】 目的探讨带膜支架腔内修复联合解剖外旁路术对 Stanford A 型主动脉夹层的临床效果。方法通过建立各种解剖外旁路来重建无名动脉、左颈总动脉或左锁骨下动脉以延长锚定区,然后一期或分期行带膜支架主动脉腔内修复术;可采取颈动脉入路或股动脉入路来完成主动脉腔内修复术。结果全组34例中升主动脉夹层8例,主动脉弓部夹层26例,除1例术中死亡外,其余33例均成功接受带膜支架主动脉腔内修复术。30d 病死率为8.8%(3/34),内漏发生率为11.8%(4/34),脑梗死发生率为5.9%(2/34)。随访6～70个月,平均24.5个月,2例失访。结果显示假腔内完全血栓形成16例,部分血栓形成13例。结论带膜支架腔内修复联合解剖外旁路术为 Stanford A 型主动脉夹层提供了一种新的治疗方法,具有微创、安全性较高,并发症较少的特点,但应注意适应证的选择。更多还原

【Abstract】 Objective To evaluate the effects of endovascular stent-graft repair for Stanford type A aortic dissection combined with extra-anatomic bypass.Methods To perform endovascular repair for Stanford type A aortic dissection,we tried to extend the landing zone by extra-anatomic bypass to reconstruet the innominate artery,the left common carotid artery or the left subclavian artery,and then achieved the process immediately or at a secondary stage via either the carotid or the femoral approach.Results Thirty- four patients with ascending aortic dissection(n=8)and aortic arch dissection(n=26)were treated with this technique.Thirty three patients were successfully done aortic endovascular repair,only one died during the operation.The thirty-day mortality rate was 8.8%(3/34),endoleak incidence rate was 11.8%(4/34) and incidence rate of cerebral infarction was 5.9%(2/34).Twenty-nine patients were followed-up for 6-70 months(mean,24.5 months).Complete(n=16)and partial(n=13)thrombosis of the false lumen were showed with CT angiography and/or vascular color Doppler ultrasound scanning.Conclusions Endovascular stent-graft repair combined with extra-anatomic bypass can be a novel option for Stanford type A aortic dissection;it is safe,less invasive,and with fewer complications.Nevertheless,indications need further consideration.更多还原