急性A型主动脉夹层术后主动脉远端TEVAR的效果分析
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R654.2

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国家自然科学基金(82200340)


Effect of distal aortic TEVAR after acute type A aortic dissection surgery
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    目的:探讨Stanford A型主动脉夹层(type A aortic dissection,TAAD)术后主动脉远端扩张及支架所致的新发破口 (stent induced new entry,SINE)的患者采取胸主动脉腔内血管修复术(thoracic endovascular aortic repair,TEVAR)治疗的安全性及有效性。方法:回顾性分析南京医科大学第一附属医院2018年1月—2023年3月连续收治的27例TAAD术后支架象鼻远端再次TEVAR治疗的患者,统计分析27例患者孙氏手术(主动脉全弓替换+降主动脉术中支架置入术)术中资料,孙氏手术后早期随访结果、TEVAR术中资料以及术后随访结果。结果:TEVAR术后随访率92.3%,随访时间为(35±21)个月。远期死亡2 例,病死率7.4%,无主动脉相关死亡病例。TEVAR术后均未出现支架内漏、移位、下肢截瘫、新发透析(TEVAR术后新发肾功能不全)、肠缺血或坏死等后遗症。在随访的病例中,成功收集术前及术后复查胸腹部大血管计算机断层扫描血管造影(com- puted tomographic angiography,CTA)25例(92.3%),术后6个月复查CTA提示支架象鼻远端破口均覆盖完全,胸主动脉覆膜支架远端真腔打开程度均满意,内脏区及下肢血管通畅程度为100%,术后1年随访患者19例,其中胸主动脉覆膜支架周围段完全血栓化13例(68.4%),部分血栓化6例(31.6%),真腔有效打开,支架覆盖区域真腔明显增大,假腔缩小。结论:急性A型主动脉夹层术后主动脉远端TEVAR治疗效果显著,无明显不良事件发生,是值得推广的手术方案。

    Abstract:

    Objective:To investigate the safety and efficacy of thoracic endovascular aortic repair(TEVAR)in patients with stent induced new entry(SINE)in the distal aortic dilation following surgical repair of type A aortic dissection(TAAD). Methods:A retrospective analysis was performed on 27 consecutive patients who underwent TEVAR for stent graft-induced distal aortic dilation in Nanjing Medical University First Affiliated Hospital from January 2018 to March 2023. The intraoperative data of 27 patients with Sun’s surgery(total aortic arch replacement plus stented elephant trunk implantation),early postoperative follow-up results of Sun’s surgery, intraoperative data of 27 patients with TEVAR and postoperative follow-up results were statistically analyzed. Results:The follow-up rate after TEVAR was 92.3%,with a mean follow-up time of(35±21)months. There were two cases of long-term mortality,resulting in a mortality rate of 7.4%,with no deaths related to aortic complications. No stent graft leak,displacement,paraplegia,new-onset dialysis (post-TEVAR new-onset renal dysfunction),intestinal ischemia,or necrosis was observed after TEVAR. Among the follow-up cases, preoperative and postoperative computed tomographic angiography(CTA)of the thoracoabdominal vessels were successfully obtained in 25 cases(92.3%). At 6 months postoperatively,CTA revealed that the rupture was completely covered,the distal true cavity opening of the thoracic aorta was satisfactory,and the vascular patency of the internal organs and lower limbs was 100% . 19 patients were followed up 1 year after surgery. Among them,there were 13 cases(68.4%)of complete thrombolysis and 6 cases(31.6%)of partial thrombolysis,the true lumen was effectively opened,the true lumen of the stent covered area was significantly enlarged,and the false lumen was reduced. Conclusion:TEVAR treatment of distal aorta after acute type A aortic dissection is effective without significant adverse events,making it a recommended surgical approach .

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沈健,倪布清,李明辉.急性A型主动脉夹层术后主动脉远端TEVAR的效果分析[J].南京医科大学学报(自然科学版),2024,(2):205-209

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  • 收稿日期:2023-09-29
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  • 在线发布日期: 2024-02-05
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