【摘要】 目的总结Stanford B型主动脉夹层真腔闭塞的诊治体会,并探讨导丝进入真腔的技巧及注意事项。方法对2006年1月至2013年12月施行手术的151例Stanford B型主动脉夹层患者的临床资料进行回顾性分析。术中主动脉造影发现8例真腔闭塞的病例,导丝进入真腔时采取了下列操作技巧:沿途造影法、导丝上下贯通法、左肱动脉穿刺向下探通法及破口多角度造影法等方法确保导丝进入真腔。结果通过上述导丝进入真腔的方法及技巧,7例支架型人造血管成功隔绝夹层破口,被证实为"真腔假闭塞";1例导丝无法进入真腔未能成功实施手术,被证实为真腔闭塞,放弃手术而采取保守治疗。结论术前、术中应仔细评估患者血管条件,利用多种血管腔内技术确保导丝顺利正确地进入真腔,以提高手术成功率。更多还原

【Abstract】 Objective To review the endovascular treatment for resolving the difficulties of entering into the true lumen of Stanford type B aortic dissection during endovascular graft exclusion. Methods From January 2006 to December 2013, 151 cases with Stanford type B aortic dissection were analyzed retrospectively. Occlusion of the true lumen were observed in 8 cases in which the wire was difficult to enter into the true lumen. Some methods were used to resolve this problem including catheter imaging technique, guide wire transfixion between proximal and distal, left brachial artery puncture to test a low-pass up, different position projection and other methods to ensure that the guide wire entered into the true lumen. Results Seven cases were confirmed to be sham occlusion of the true lumen. The guide wire could not enter into the true lumen in 1 case which was proved to be true lumen occlusion. This patient received conservative treatment instead of surgery. Conclusions Vascular condition should be evaluated carefully preoperatively and intraoperatively. Varieties of endovascular techniques should be used to ensure that the wire entered into the true lumen and increase successful rate.更多还原