目的著重從力學(xué)損傷的角度分析胸主動脈腔內(nèi)修復(fù)(TEVAR)術(shù)后并發(fā)人工血管內(nèi)支架(簡稱支架)源性新破口(SINE)的原因及其防治措施。方法本研究中SINE定義為: 排除了腔內(nèi)操作導(dǎo)致的醫(yī)源性損傷和自然病程進(jìn)展，由支架本身引起的、發(fā)生在支架兩端的新破口，出現(xiàn)在支架近端和遠(yuǎn)端者分別稱為近端SINE和遠(yuǎn)端SINE?；仡櫺允占?000年8月至2008年6月期間在我院接受TEVAR治療的650例Stanford B型主動脈夾層中22例并發(fā)SINE患者的臨床資料，另有1例Stanford B型主動脈夾層在外院完成初次TEVAR后14個月并發(fā)遠(yuǎn)端SINE來我院治療。分析SINE發(fā)生的時間、臨床表現(xiàn)、治療、隨訪效果及其原因。結(jié)果本組有23例SINE共24處破口，其中近端SINE 15例(16處)，遠(yuǎn)端SINE 7例(8處)，1例患者先后在支架近、遠(yuǎn)端出現(xiàn)破口。我院SINE總體發(fā)生率為3.4%(22/650)，死亡6例，死亡率為26.1%(6/23)。16處近端SINE均位于主動脈弓大彎側(cè)，導(dǎo)致逆行性A型夾層。8處遠(yuǎn)端SINE均出現(xiàn)在撕裂的內(nèi)膜片一側(cè)，其中5例引起夾層動脈瘤持續(xù)增大，3例隨訪穩(wěn)定。23例患者初次TEVAR治療中支架均跨主動脈弓降部釋放。結(jié)論TEVAR術(shù)后并發(fā)SINE并不罕見，死亡率高。支架導(dǎo)致的力學(xué)損傷是SINE形成的重要潛在因素，支架設(shè)計(jì)和圍手術(shù)期評估時重視該因素的評估具有重要意義。
引用本文： 董智慧,符偉國,王玉琦,郭大喬,徐欣,陳斌,蔣俊豪,楊玨,史振宇,竺挺,石赟. 胸主動脈腔內(nèi)修復(fù)術(shù)后支架源性新破口——從支架力學(xué)損傷角度的思考. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(10): 1031-1038. doi: 復(fù)制
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| 1. | Dong ZH, Fu WG, Wang YQ, et al. Retrograde type a aortic dissection after endovascular stent graft placement for treatment of type B dissection [J]. Circulation, 2009, 119(5): 735741. |
| 2. | Fu WG, Shi Y, Wang YQ, et al. Endovascular therapy for stanford type B aortic dissection in 102 cases [J]. Asian J Surg, 2005, 28(4): 271276. |
| 3. | Fu WG, Dong ZH, Wang YQ, et al. Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair [J]. Chin Med J (Engl), 2005, 118(13): 10661071. |
| 4. | Steingruber IE, Chemelli A, Glodny B, et al. Endovascular repair of acute type B aortic dissection:midterm results [J]. J Endovasc Ther, 2008, 15(2): 150160. |
| 5. | Neuhauser B, Czermak BV, Fish J, et al. Type a dissection following endovascular thoracic aortic stentgraft repair [J]. J Endovasc Ther, 2005, 12(1): 7481. |
| 6. | Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type a dissection after endovascular stenting of the descending thoracic aorta. is the risk real? [J]. Eur J Cardiothorac Surg, 2008, 33(6): 10141018. |
| 7. | Fanelli F, Salvatori FM, Marcelli G, et al. Type a aortic dissection developing during endovascular repair of an acute type B dissection [J]. J Endovasc Ther, 2003, 10(2): 254259. |
- 1. Dong ZH, Fu WG, Wang YQ, et al. Retrograde type a aortic dissection after endovascular stent graft placement for treatment of type B dissection [J]. Circulation, 2009, 119(5): 735741.
- 2. Fu WG, Shi Y, Wang YQ, et al. Endovascular therapy for stanford type B aortic dissection in 102 cases [J]. Asian J Surg, 2005, 28(4): 271276.
- 3. Fu WG, Dong ZH, Wang YQ, et al. Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair [J]. Chin Med J (Engl), 2005, 118(13): 10661071.
- 4. Steingruber IE, Chemelli A, Glodny B, et al. Endovascular repair of acute type B aortic dissection:midterm results [J]. J Endovasc Ther, 2008, 15(2): 150160.
- 5. Neuhauser B, Czermak BV, Fish J, et al. Type a dissection following endovascular thoracic aortic stentgraft repair [J]. J Endovasc Ther, 2005, 12(1): 7481.
- 6. Kpodonu J, Preventza O, Ramaiah VG, et al. Retrograde type a dissection after endovascular stenting of the descending thoracic aorta. is the risk real? [J]. Eur J Cardiothorac Surg, 2008, 33(6): 10141018.
- 7. Fanelli F, Salvatori FM, Marcelli G, et al. Type a aortic dissection developing during endovascular repair of an acute type B dissection [J]. J Endovasc Ther, 2003, 10(2): 254259.