A型主动脉夹层行主动脉弓杂交修复术后远端夹层形成的原因分析及治疗

摘要

目的：分析A型主动脉夹层行主动脉弓杂交修复术后远端夹层形成的原因及再治疗术式选择。方法：回顾性分析2011年3月-2012年9月本科收治的3例A型夹层行主动脉弓杂交修复术后患者，术后常规复查发现支架远端出现新发破口，均再次行主动脉夹层腔内修复术。结果：随访至2013年9月，3例患者未再出现新发破口，真腔均完全打开，假腔未见显影。结论：主动脉弓杂交修复术治疗A型主动脉夹层作为一种新兴术式较传统主动脉弓替换+支架“象鼻”术相比能明显简化手术，降低围手术期死亡率，但随着手术例数逐渐增多，其远端夹层形成作为严重并发症不容忽视，提示该术式尚需进一步完善及更多临床验证，而腔内治疗仍可作为再次修复的首选。%Objective:To analyze the cause of distal dissection after hybrid repair of Stanford type A aortic dissection(TAAD)through aortic arch and discuss its therapy.Method:The clinical data of 3 cases of TAAD treated by hybrid repair through aortic arch from March 2011 to September 2012 were retrospectively analyzed. All the 3 cases were found novel rupture in the distal end of arterial stent in postoperative regular review and received endovascular treatment. Result:Follow-up till to September 2013,there was no novel rupture in all the cases,true lumens were completely opened,and false cavity disappeared.Conclusion:Compared with traditional aortic arch replacement+stent elephant trunk procedure,hybrid repair through aortic arch simplified operation and reduced perioperative mortality,but with the development of this procedure,the complication that distal dissection formation should not be ignored. Sever complication implied this procedure should be improved and its benefit need more clinical advance.What’more,when complication occurred,endovascular repair still should be the first choice.