支架型人工血管治疗DeBakeyⅢ型主动脉夹层后的主动脉重构

Aortic remodeling after endovascular stent-grafts for DeBakey Ⅲ type aortic dissection

关键词:  主动脉夹层  支架型人工血管  主动脉重构

Key words:  aorta dissection  endovascular stent-graft  aorta remodel

摘要:

目的探讨支架型人工血管(stent-grafts)治疗DeBakeyⅢ型主动脉夹层术后夹层真假腔转归变化和主动脉重构情况。方法分析2003年2月到2008年3月有完整住院资料及随访资料的112例Ⅲ型主动脉夹层患者资料。经支架型人工血管治疗的112例主动脉夹层患者(平均56.6岁,男性94例)中,急性期病例54例(48.2%,平均63.8 h),慢性期58例(51.8%,平均22.3个月)。影像学观察术后夹层的形态学改变及假腔内血栓形成情况,测量主动脉不同部分真腔(true lumen TL),假腔(false lumen FL)及主动脉腔(whole lumen WL)直径的改变并计算真腔指数(TL index TLi)和假腔指数(FL index FLi),统计分析用配对t检验和χ²检验。结果平均随访25个月,术后TLi明显增加,FLi明显降低,差别有统计学意义。结论血管腔内支架型人工血管治疗主动脉DeBakeyⅢ型夹层可封闭原发破口,使真腔增大,假腔减小并血栓形成,主动脉重构以恢复正常血流动力学。

Abstract:

Objective To assess the aortic remodeling after endovascular stent-graft for DeBakey Ⅲ type aortic dissections.Methods One hundred and twelve patients（94 males and 18 females,mean age 56.6 years）with DeBakey Ⅲ type aortic dissections underwent endovascular stent-grafts from February 2003 to March 2008,including 54 acute cases（48.2%） and 58 chronic cases（51.8%）.Preprocedural and follow-up computed tomography scans were performed,indices of true lumen（TLi=TL/WL） and false lumen（FLi=FL/ WL） were calculated at the proximal（p）,middle（m）,and distal（d） third of the descending thoracic aorta.Paired t test and χ² were used for statistical analysis.Results The mean followed up period was 25 months,compared the pre-procedure the TLi was significantly increased and FLi was significantly reduced after stent-grafts.Conclusion Endografting is effective for DeBakey Ⅲ type aortic dissection,which can promote positive aortic remodeling changes.