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封堵器联合裸支架治疗破口位于腹腔分支动脉区域的主动脉夹层

Combined use of occluder plus bare stent in the treatment of aortic dissection with tear at the area of visceral branches

摘要:

目的 探讨封堵器联合裸支架治疗破口位于腹腔分支动脉区域主动脉夹层的效果.方法 2010年4月至2012年9月,6例Stanford B型主动脉夹层患者(男性5例,女性1例,年龄29~62岁,平均年龄47.2岁)接受腔内治疗.以覆膜支架将主要破口封闭后,确认位于腹腔分支动脉区域的破口难以白愈,采用封堵器置于破口处,前盘位于假腔,后盘位于真腔,并在真腔内植入适当口径的裸支架,将后盘推挤贴壁.结果 6例患者中5例封堵器置入成功,1例破口处封堵器无法锚定,改用弹簧圈栓塞假腔.术后即时造影,5例使用封堵器者假腔不显影,腹腔分支动脉通畅.1例改弹簧圈栓塞者,少量造影剂弥散至弹簧圈局部,假腔不显影,分支动脉通畅.无截瘫、内脏功能损害及其他并发症发生.结论 封堵器联合裸支架治疗破口位于腹腔分支动脉区域的主动脉夹层,仅用两项简单技术进行组合,易于掌握,解决了常规覆膜支架无法治疗区域的病变,避免了开放手术、杂交手术相关的巨大创伤.

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abstracts:

Objective To evaluate the novel method of combinedly use of occluder and bare stent in the treatment of aortic dissection with distal tear at visceral branches.Methods From April 2010 to September 2012,6 patients (5 male and 1 female patients,aged from 29 to 62 years,mean 47.2 years) were diagnosed as Stanford type B aortic dissection that been revealed by CT angiography.The main tears were sealed with stent-grafts firstly,and then the tears at the visceral branch area were evaluated that impossible to close spontaneously.Atrium septal defect occluder and ventricular septal defect were implanted at the tears with the anterior disc in false lumen,while the posterior disc in the true lumen.After that,the bare stents were implanted in the true lumen to pull the occluders on the aortic wall.Results Among the 6 procedures,occluders were successfully implanted in 5 cases,and 1 failed anchoring at the tear,and the alternative method of coils embolization was applicated.After all the procedures,the immediate aortogrophy revealed that the false lumen disappeared in the 5 cases that occluders were used,and the visceral branches were all patent.No paraplegia,lesion of visceral organs or other complications occurred.All the cases were followed at least 5 months.There was one endoleak due to a non-sealed tear at the descending aorta,one new-occurred small tear in the descending aorta but with no communication to the false lumen.Conclusions The combinedly use of occluder and bare stent in the treatment of aortic dissection with tears at the visceral branch area is a sum of two simple technique plus each other.It is easily to master.The lesions at the aortic that ordinary stent-grafting incapable to seal are successfully solved then.The huge trauma of open or hybrid procedures are avoided.

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