• 復旦大學附屬中山醫(yī)院血管外科(上海 200032);

目的著重從力學損傷的角度分析胸主動脈腔內修復(TEVAR)術后并發(fā)人工血管內支架(簡稱支架)源性新破口(SINE)的原因及其防治措施。方法本研究中SINE定義為: 排除了腔內操作導致的醫(yī)源性損傷和自然病程進展，由支架本身引起的、發(fā)生在支架兩端的新破口，出現在支架近端和遠端者分別稱為近端SINE和遠端SINE?；仡櫺允占?000年8月至2008年6月期間在我院接受TEVAR治療的650例Stanford B型主動脈夾層中22例并發(fā)SINE患者的臨床資料，另有1例Stanford B型主動脈夾層在外院完成初次TEVAR后14個月并發(fā)遠端SINE來我院治療。分析SINE發(fā)生的時間、臨床表現、治療、隨訪效果及其原因。結果本組有23例SINE共24處破口，其中近端SINE 15例(16處)，遠端SINE 7例(8處)，1例患者先后在支架近、遠端出現破口。我院SINE總體發(fā)生率為3.4%(22/650)，死亡6例，死亡率為26.1%(6/23)。16處近端SINE均位于主動脈弓大彎側，導致逆行性A型夾層。8處遠端SINE均出現在撕裂的內膜片一側，其中5例引起夾層動脈瘤持續(xù)增大，3例隨訪穩(wěn)定。23例患者初次TEVAR治療中支架均跨主動脈弓降部釋放。結論TEVAR術后并發(fā)SINE并不罕見，死亡率高。支架導致的力學損傷是SINE形成的重要潛在因素，支架設計和圍手術期評估時重視該因素的評估具有重要意義。

引用本文： 董智慧,符偉國,王玉琦,郭大喬,徐欣,陳斌,蔣俊豪,楊玨,史振宇,竺挺,石赟. 胸主動脈腔內修復術后支架源性新破口——從支架力學損傷角度的思考. 中國普外基礎與臨床雜志, 2011, 18(10): 1031-1038. doi: 復制

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  1. 1. Dong ZH, Fu WG, Wang YQ, et al. Retrograde type a aortic dissection after endovascular stent graft placement for treatment of type B dissection [J]. Circulation, 2009, 119(5): 735741.
  2. 2. Fu WG, Shi Y, Wang YQ, et al. Endovascular therapy for stanford type B aortic dissection in 102 cases [J]. Asian J Surg, 2005, 28(4): 271276.
  3. 3. Fu WG, Dong ZH, Wang YQ, et al. Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair [J]. Chin Med J (Engl), 2005, 118(13): 10661071.
  4. 4. Steingruber IE, Chemelli A, Glodny B, et al. Endovascular repair of acute type B aortic dissection:midterm results [J]. J Endovasc Ther, 2008, 15(2): 150160.
  5. 5. Neuhauser B, Czermak BV, Fish J, et al. Type a dissection following endovascular thoracic aortic stentgraft repair [J]. J Endovasc Ther, 2005, 12(1): 7481.
  6. 6. Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type a dissection after endovascular stenting of the descending thoracic aorta. is the risk real? [J]. Eur J Cardiothorac Surg, 2008, 33(6): 10141018.
  7. 7. Fanelli F, Salvatori FM, Marcelli G, et al. Type a aortic dissection developing during endovascular repair of an acute type B dissection [J]. J Endovasc Ther, 2003, 10(2): 254259.