摘要目的 总结胸主动脉腔内修复术后再发主动脉A型夹层的原因及外科治疗效果.方法 2009年3月至2014年3月,17例患者行胸主动脉支架术后发生A型夹层.男13例,女4例;平均年龄53岁.原发疾病为主动脉B型夹层13例,真性动脉瘤及主动脉溃疡各2例.患者均接受主动脉根部/升主动脉、全弓替换加象鼻支架置人术.出院患者均经门诊复查和电话随访.结果 再发A型夹层时间距首次手术平均250天,其中5例于初次手术后住院期间发现,12例门诊随访时发现.12例A型夹层原发破口位于原支架近端金属裸支架区,2例靠近裸支架并伴有内膜划痕损伤,3例破口位于升主动脉伴升主动脉及窦扩张.术后早期1例死亡.术后随访(35±21)个月,5年生存率87.5％,5年免再手术率85.7％.结论 胸主动脉支架术后再发A型夹层与近端金属裸支架明显相关,采用全弓替换加象鼻支架术治疗再发A型夹层早、中期效果良好.

abstractsObjective To analyze the etiology and surgical results through 17 cases with retrograde aortic dissection after thoracic endovascular repair.Methods From March 2009 to March 2014,17 patients were diagnosed with retrograde type A aortic dissection after thoracic endovascular repair,the mean age was 53 years,13 male and 4 female.Type B aortic dissection as the primary disease were 13 cases,aortic aneurysm and aortic ulcer were 2 cases respectively.All cases with new type A aortic dissection were diagnosed by cardiac ultrasound and aortic computed tomography.All patients were received aortic root and total aortic arch replacement plus elephant trunk procedure.All patients were followed by clinic interview or telephone.Results The interval time was from 1 to 2 200 days,5 patients were diagnosed before discharge,12 patients during clinical follow-up.The primary tear in 12 patients were located the area which were anchored by bare mental stent,in 2 cases were nearby the bare stent,the other 3 cases were located anterior part of ascending aorta.1 patient was died due to cerebral hemorrhage after operation.3 patients had renal insufficiency after operation and all were cured by hemofiltration;neurological complication occurred in 3 patients including that 1 patient stroked,1 patient cerebral hemorrhage and 1 patient had transient brain dysfunction,4 patients had pulmonary complication and 2 patients with intestinal dysfunction.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time was(35-±21) months.2 cases were died during follow-up and five-year survival rate was 87.5 ％.One patient was reoperation with total thoracic abdominal aorta replacement,five-year free from reoperation was 85.7％.Conclusion The retrograde type A dissection after thoracic endovascular repair were closely related with proximal bare mental stent,part of cases were silent symptom,the clinical fellow with aortic enhanced computed tomography were necessary to detect the serious complication.Operation scheme was safely and effectively,aortic arch replacement plus elephant trunk procedure was the preferred method to repair retrograde aortic dissection.