胸主动脉腔内修复术联合限制性裸支架治疗B型主动脉夹层对术后主动脉重塑的影响
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欧阳洋, Email: oyyking@126.com

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Influence of thoracic endovascular aortic repair plus restrictive bare stent implantation for type B aortic dissection on postoperative aortic remodeling
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    (中南大学湘雅医院 1. 放射科 2. 血管外科,湖南 长沙 410008)

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    Objective: To investigate the influence of thoracic endovascular aortic repair (TEVAR) combined with restrictive bare stent (RBS) implantation on postoperative aortic remodeling in treatment of aortic dissection. Methods: The data of 20 patients with type B aortic dissection treated from August 2012 to August 2014 were retrospectively analyzed. Of the patients, 11 cases underwent TEVAR alone (TEVAR group), and 9 cases received TEVAR plus RBS implantation (TEVAR+RBS group). According to the preoperative and postoperative follow-up CTA data, the relevant variables related to postoperative aortic remodeling were compared between the two groups of patients. Results: The operative success rate was 100% for either group, and no postoperative complications such as paraplegia, stroke, and aortic rupture occurred. The mean overlap length of RBS and covered stent was 36.5 mm in TEVAR+RBS group. Compared with TEVAR group, the oversizing rate of entire true lumen volume (34.9% vs. 64.9%, P=0.011), the area distal to the covered stent graft (43.5% vs. 107.3%, P=0.006) and the longest diameter distal to the covered stent graft (–12.2% vs. 18.5%, P=0.002) in TEVAR+RBS group were all significantly reduced. There was no significant difference between TEVAR group and TEVAR+RBS group in shrinkage rate of the false lumen volume (74.8% vs.65.3%, P=0.328) and the false lumen thrombosis rate (56.8% vs. 47.3%, P=0.271). Conclusion: Compared with TEVAR alone, TEVAR combined with RBS for aortic dissection shows no superiority in improving postoperative aortic remodeling. However, it can effectively decrease the oversizing of the area (or longest diameter) of the true lumen distal to the stent, and thereby may reduce the incidence of distal stent graft-induced new entry.

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周春晖|欧阳洋|李刚|黄建华|赵磊|吴楠.胸主动脉腔内修复术联合限制性裸支架治疗B型主动脉夹层对术后主动脉重塑的影响[J].中国普通外科杂志,2016,25(12):1694-1700.
DOI:10.3978/j. issn.1005-6947.2016.12.005

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  • 收稿日期:2016-05-31
  • 最后修改日期:2016-11-08
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  • 在线发布日期: 2016-12-15