目的：探讨腔内隔绝治疗Stanford B型胸主动脉夹层动脉瘤（ thoracic aortic dissection ，TAD）术中建立覆膜支架输送轨道的方法。方法对2005年10月～2013年9月行胸主动脉腔内修复术（ thoracic endovascular aortic repair ，TEVAR）治疗的Stanford B型TAD 81例进行回顾性分析。手术均在数字减影血管造影（ digital subtraction angiography ，DSA）监视下完成，术中使用进入真腔建立输送轨道的方法有导管沿途造影法45例、增强器切线位造影法16例、左肱动脉和股动脉导管双向造影法12例、导丝漂流上下贯通法8例。结果81例均成功进入真腔，覆膜支架成功隔绝夹层裂口。78例随访3～26个月，平均13．4月，无支架移位、血栓形成等并发症，2例出现Ⅱ型内漏。结论 TEVAR为确保导丝导管在真腔内，使支架准确放置真腔，可根据具体情况选择多种造影方法，建立有效的输送轨道。%Objective To investigate methods of establishing track delivery in the endovascular treatment of Stanford B type thoracic aortic dissection (TAD). Methods From October 2005 to September 2013, 81 cases of Stanford B type TAD were treated . Operations were performed under digital subtraction angiography ( DSA ) guidance .Intraoperatively , methods of establishing track delivery included “along the way” catheter angiography (45 cases), enhanced tangential angiography (16 cases), the left brachial artery and femoral artery two-way catheter angiography (12 cases), and guide wire drifting through up and down (8 cases). Results The catheter was successfully entered the true lumen in all the 81 cases.The interlayer gap was successfully isolated by stents . Seventy-eight cases were followed up for 3 -26 months ( mean, 13.4 months ).No stent migration, thrombosis, and other complications occurred .There were 2 cases of type Ⅱ endoleak . Conclusion To ensure the guide wire or catheter and stent entering the true lumen in thoracic endovascular aortic repair , effective delivery track can be established by a variety of imaging methods depending on patients ’ conditions .
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