覆膜支架主动脉腔内修复术治疗创伤性主动脉破裂

发表时间：2014-06-16 浏览次数：1192次

引用：

杨帆，杨建，于风旭等.覆膜支架主动脉腔内修复术治疗创伤性主动脉破裂[J].中华创伤杂志.2013, 29(3):211-215

关键词：

创伤性胸主动脉损伤,主动脉腔内修复术,急性主动脉破裂,主动脉壁内血肿,损伤控制手术

作者：

杨帆，杨建，于风旭，廖斌，邓明彬，康慧，方易冰

作者单位：

646000,泸州医学院附属医院胸心外科;四川大学华西医院胸心血管外科

出版年份：

2013

期刊页数：

211-215

收录者：

知网,万方

摘要：

目的探讨覆膜支架主动脉腔内修复术(endovascular aortic repair,EVAR)治疗创伤性胸主动脉损伤(traumatic thoracic aortic injuries,TTAI)的可行性和有效性. 方法回顾性分析13例TTAI患者的临床资料,术前螺旋CT血管造影(CTA)对病变进行评估,术中数字减影血管造影(DSA)进一步评估及行EVAR.术后3,6,12个月以及其后每年随访CTA明确治疗效果. 结果 13例行EVAR均获成功.完全或部分遮蔽左锁骨下动脉4例,支架释放后即刻造影发现内漏3例,加短支架2次覆盖后内漏消失1例,行球囊扩张贴附后内漏明显减少1例,另1例微小内漏予观察随访.共12例获随访,无内漏、左上肢缺血、截瘫以及支架移位等并发症. 结论 EVR治疗TTAI安全性高,效果满意. Objective To investigate feasibility and validity of endovascular aortic repair (EVAR) of traumatic thoracic aortic injuries (TTAI).Methods A retrospective analysis was conducted on data of 13 patients with TTAI.Pathological changes were evaluated by spinal CT angiography (CTA) preoperatively and re-evaluated by digital subtraction angiography (DSA) in EVAR.CTA was performed again to confirm therapeutic effects at postoperative 3,6,12 months and annually thereafter.Results All patients had successful EVAR.Complete or partial cover of left subclavian artery was observed in four patients.Endoleak in angiography shortly after stent delivery was noticed in three patients.However,endoleak disappeared in one patient after short stent placement for twice; endoleak was evidently decreased in one patient after balloon dilation.Follow-up was performed for another patient with slight endoleak.A total of 12 patients were followed up,which showed no complications,such as endoleak,ischemia of left upper extremity,paralysis or stent-graft migration.Conclusion EVR is safe and effective in treatment of TTAI.

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