Stanford B型胸主动脉夹层腔内修复术后内漏分析研究

doi:10.3969/j.issn.1000-8535.2020.06.009

广州医药 ›› 2020, Vol. 51 ›› Issue (6): 46-49.DOI: 10.3969/j.issn.1000-8535.2020.06.009

Stanford B型胸主动脉夹层腔内修复术后内漏分析研究

李杰¹, 王丽娟², 王家平¹, 童玉云¹, 杨素萍¹

1 昆明医科大学第二附属医院放射科(昆明 650101)
2 昆明市延安医院放射科(昆明650200)

收稿日期:2020-04-14 出版日期:2020-11-20 发布日期:2021-11-28
通讯作者: 王丽娟,E-mail:wlj7412@163.com
基金资助:
云南省医学学科带头人培养计划(D-201647)

Analysis and clinical study of the endoleak after thoracic endovascular aortic repair for Stanford type B aortic dissection

LI Jie¹, WANG Lijuan², WANG Jiaping¹, TONG Yuyun¹, YANG Suping¹

1 Department of Radiology,Second Affiliated Hospital of Kunming Medical University,Kunming 650101, China
2 Department of Radiology, Affiliated to Yan'An Hospital of Kunming Medical University,Kunming 650200, China

Received:2020-04-14 Online:2020-11-20 Published:2021-11-28

摘要/Abstract

摘要： 目的探讨Stanford B型胸主动脉夹层腔内修复(TEVAR)术后不同类型内漏的产生机制及处理措施。方法收集整理2008年9月—2017年2月间在我院诊断为Stanford B型胸主动脉夹层并接受TEVAR术治疗的105例患者的临床及影像资料,分析术中及术后出现内漏的原因,根据内漏来源及渗漏量给予不同处理,观察处理后内漏的变化情况。结果术中出现急性内漏11例,包括Ⅰ型内漏8例(7.6%)和Ⅱ型内漏3例(2.8%);迟发内漏3例,包括Ⅰ型内漏1例(1.0%)和Ⅱ型内漏2例(1.9%),内漏总发生率为13.3%。术后患者未出现支架移位、截瘫、肾动脉缺血等严重并发症。结论根据内漏产生的原因不同,内漏分为5型,其中Ⅰ型及Ⅱ型内漏较为常见,不同类型内漏处理方式不同,正确判断内漏类型是合理、有效处理内漏的前提。

关键词: 主动脉夹层, 胸主动脉腔内修复术, 内漏

Abstract: Objective To investigate the causes of different types of endoleak after thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection, and to discuss its management. Methods The clinical data and imaging data of 105 patients with Stanford type B aortic dissection, who were admitted to authors' hospital during the period from September 2008 to February 2017 to receive TEVAR, were collected and reviewed. Reasons of intraoperative endoleak or after operation were analyzed, different treatments for the source of endoleak and leakage were taken and the conversions followed were observed. Results Acute endoleak was occurred in 11 patients during operation, including endoleak typeⅠ (n=8,7.6%)and endoleak type Ⅱ (n=3,2.8%). Delayed endoleak was seen in 3 patients, including endoleak typeⅠ (n=1,1.0%)and endoleak type Ⅱ (n=2,1.9%). Both in-operative and postoperative endoleak occurred in 14 patients (13.3%). After TEVAR, no serious complications such as displacement of stent, paraplegia or renal artery ischemia occurred. Conclusion According to the different reasons, endoleak can be divided into five types, among them, type Ⅰ and type Ⅱ are most common. Different endoleak should be handle in different ways.Correct judgment of endoleak type is the premise of reasonable and effective treatment for endoleak.

Key words: Aortic dissection, Thoracic endovascular aortic repair, Endoleak

李杰, 王丽娟, 王家平, 童玉云, 杨素萍. Stanford B型胸主动脉夹层腔内修复术后内漏分析研究[J]. 广州医药, 2020, 51(6): 46-49.

LI Jie, WANG Lijuan, WANG Jiaping, TONG Yuyun, YANG Suping. Analysis and clinical study of the endoleak after thoracic endovascular aortic repair for Stanford type B aortic dissection[J]. Guangzhou Medical Journal, 2020, 51(6): 46-49.

参考文献

[1] STELZMUELLER M E, NOLZ R, MAHR S, et al.Thoracic endovascular repair for acute complicated type B aortic dissections[J].J VascSurg, 2019, 269(2):318-326.
[2] 罗建光,肖恩华,周顺科,等. 胸主动脉夹层动脉瘤血管内支架介入治疗[J].临床放射学杂志, 2006, 25(11):1046-1050.
[3] 万珊杉,吴敏,王家平,等. 胸主动脉夹层腔内修复术内漏研究[J].介入放射学杂志, 2016, 25(10):908-911.
[4] CAO P, DE RANGO P, VERZINI F, et al.Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair[J].J Cardiovasc Surg (Torino),2010, 51(1):53-69.
[5] CHAIKOF E L, BLANKENSTEIJN J D, HARRIS P L, et al.Reporting standards for endovascular aortic aneurysm repair[J].J Vasc Surg, 2002, 35(5):1048-1060.
[6] WHITE G H, YU W, MAY J.Endoleak-a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft[J].J Endo Vasc Surg,1996, 3(1):124-125.
[7] 刘艳杰,王效增,周铁楠.型主动脉夹层腔内修复术后近端内漏再次置入覆膜支架双丝技术运用例[J].创伤与急危重病医学, 2017, 5(6):340-342.
[8] RUAN Z B, ZHU L, YIN Y G, et al.Risk factors of early and late mortality after thoracic endovascular aortic repair for complicated stanford B acute aortic dissection[J]. J Card Surg, 2014, 29(4):501-506.
[9] 贡鸣,黄小勇,王晓龙,等. 型主动脉夹层胸主动脉腔内修复术后Ⅰ型内漏的治疗[J].临床心血管病杂志, 2014, 30(6):513-516.
[10] JONES J E, ATKINS M D, BREWSTER D C, et al.Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes[J].J Vasc Surg, 2007, 46(1):1-8.
[11] 王深明,王冕.主动脉腔内修复术后支架相关并发症分析[J].中国血管外科杂志, 2012, 4(4):201-205.
[12] 景在平,赵珺,赵志青,等. 胸主动脉夹层腔内隔绝术后内漏的分型及意义[J].中国实用外科杂志, 2002, 22(3):154-156.
[13] 里程楠,朱俊明,齐瑞东,等. 胸部动脉腔内修复术术后近端内漏的治疗[J].中国胸心血管外科临床杂志, 2018, 25(10):870-874.
[14] KARUBE N, UCHIDA K, CHO T, et al.Coil embolization of intercostal arteries accessed by surgical exposure for type II endoleak after thoracic endovascular aortic repair[J].J Vasc Surg, 2019, 70(1):267-271.
[15] KERR N, KERR J, FAED J M, et al.Spontaneous intracerebral haemorrhage: a rare complication of aortic aneurysm endoleak[J].BMJ Case Rep, 2018, 2018(6):225249.
[16] YOON J S, SUH J H, KIM D Y, et al.Disseminated intravascular coagulopathy caused by type II endoleak after endovascular aneurysm repair in severe aortic stenosis[J].J Thorac Dis, 2017, 9(11):E994-E996.

Stanford B型胸主动脉夹层腔内修复术后内漏分析研究

Analysis and clinical study of the endoleak after thoracic endovascular aortic repair for Stanford type B aortic dissection

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