Stanford B型主动脉夹层行主动脉腔内支架置入术后早期抗凝处理
Stanford B형주동맥협층행주동맥강내지가치입술후조기항응처리
Clinical experience of early anticoagulant therapy after endovascular stent-graft exclusion for Stanford B type aortic
  • 万方数据
    中华胸心血管外科杂志 중화흉심혈관외과잡지
    Chinese Journal of Thoracic and Cardiovascular Surgery
    2012年 6期 324-327 ,共4页

    姜兆磊%梅举%丁芳宝%鲍春荣%汤敏%朱家全%马南%黄健兵%刘浩%张俊文%杨琦

    강조뢰%매거%정방보%포춘영%탕민%주가전%마남%황건병%류호%장준문%양기

    主动脉%动脉瘤,夹层%支架%腔内支架置入术%抗凝治疗 主動脈%動脈瘤,夾層%支架%腔內支架置入術%抗凝治療
    주동맥%동맥류,협층%지가%강내지가치입술%항응치료
    Aorta%Aneurysm,dissection%Stents Endovascular stent-graft exclusion%Anticoagulation
    目的 总结应用主动脉腔内支架置入术治疗Stanford B型主动脉夹层术后早期选择性抗凝处理的经验.方法 2006年6月至2011年6月,应用主动脉腔内支架置入术治疗StanfordB型主动脉夹层75例,其中男65例,女10例;年龄22～81岁,平均(59.1±13.5)岁.术前采用CT血管造影对主动脉夹层病变情况进行评估,左锁骨下动脉开口处胸降主动脉直径为22～42mm,平均(30.3±4.0)mm,夹层破口距左锁骨下动脉＞1.5cm 29例(均为右椎动脉优势),＜1.5cm 46例(左椎动脉优势2例).术中根据CT血管造影检查结果,对左椎动脉优势且术中需要封闭左锁骨下动脉的患者,先常规行左锁骨下动脉重建术.术后对支架近端完全或部分封闭左锁骨下动脉(无内漏且远端无残余破口)者,支架置入术后第2天开始予阿司匹林100mg/天抗凝,维持3个月.术后早期观察患者有无神经系统疾病的症状或体征;术后3个月行头颅及胸腹部CT,了解支架位置、假腔内血栓形成、主要分支血管血流情况及有无神经系统并发症发生.结果 75例患者均成功手术,术中主动脉支架直径26～46 mm,平均(34.3±4.0)mm.2例术前评估为左椎动脉优势,术中同期行左锁骨下动脉重建术.术中左锁骨下动脉开口完全或部分封闭58例,完全封闭19例,开口2/3封闭15例,开口1/2封闭24例;其中56例无内漏及残余破口,术后早期进行抗凝治疗,预防椎动脉血栓形成.术后早期死亡2例(2.7％),分别死于肾功能衰竭和夹层破裂,其余患者均成功治愈出院,术后住院时间4～19天,平均(7.9±3.5)天,无脑梗死或截瘫病例.随访6～66个月,1例死于呼吸系统疾病,1例于术后19月再发Stanford A型夹层行升主动脉及主动脉弓置换术,1例于术后4年因支架近端新发夹层再次行腔内支架置入术.随访期未发生脑梗死、截瘫等神经系统并发症.结论 对主动脉腔内支架置入术中完全或部分封闭左锁骨下动脉的患者,术后早期抗凝可安全、有效的预防与椎动脉血栓形成相关的神经系统并发症.
    목적 총결응용주동맥강내지가치입술치료Stanford B형주동맥협층술후조기선택성항응처리적경험.방법 2006년6월지2011년6월,응용주동맥강내지가치입술치료StanfordB형주동맥협층75례,기중남65례,녀10례;년령22～81세,평균(59.1±13.5)세.술전채용CT혈관조영대주동맥협층병변정황진행평고,좌쇄골하동맥개구처흉강주동맥직경위22～42mm,평균(30.3±4.0)mm,협층파구거좌쇄골하동맥＞1.5cm 29례(균위우추동맥우세),＜1.5cm 46례(좌추동맥우세2례).술중근거CT혈관조영검사결과,대좌추동맥우세차술중수요봉폐좌쇄골하동맥적환자,선상규행좌쇄골하동맥중건술.술후대지가근단완전혹부분봉폐좌쇄골하동맥(무내루차원단무잔여파구)자,지가치입술후제2천개시여아사필림100mg/천항응,유지3개월.술후조기관찰환자유무신경계통질병적증상혹체정;술후3개월행두로급흉복부CT,료해지가위치、가강내혈전형성、주요분지혈관혈류정황급유무신경계통병발증발생.결과 75례환자균성공수술,술중주동맥지가직경26～46 mm,평균(34.3±4.0)mm.2례술전평고위좌추동맥우세,술중동기행좌쇄골하동맥중건술.술중좌쇄골하동맥개구완전혹부분봉폐58례,완전봉폐19례,개구2/3봉폐15례,개구1/2봉폐24례;기중56례무내루급잔여파구,술후조기진행항응치료,예방추동맥혈전형성.술후조기사망2례(2.7％),분별사우신공능쇠갈화협층파렬,기여환자균성공치유출원,술후주원시간4～19천,평균(7.9±3.5)천,무뇌경사혹절탄병례.수방6～66개월,1례사우호흡계통질병,1례우술후19월재발Stanford A형협층행승주동맥급주동맥궁치환술,1례우술후4년인지가근단신발협층재차행강내지가치입술.수방기미발생뇌경사、절탄등신경계통병발증.결론 대주동맥강내지가치입술중완전혹부분봉폐좌쇄골하동맥적환자,술후조기항응가안전、유효적예방여추동맥혈전형성상관적신경계통병발증.
    Objective To summarize the preliminary experience of early anticoagulant therapy after endovascular stent graft exclusion for Stanford B type aortic dissection.Methods From June 2006 to June 2011,75 patients[ 65 males,10 fe males,mean age (59.1±13.5) years,range 22 -81 years ] under went endovascular stent-graft exclusion for Stafford B type aortic dissection in Shanghai Xinhua Hospital.Computed tomography angiography (CTA) was used to evaluate the lesions of aortic dissection before endovascular stent-graft exchusion.The descending thoracic aortic diameters were 22 mm to 42 mm [ mean (30.3±4.0) mm ].The distance from the breakage of dissection to the left vertebral artery(LSA)was longer than 1.5 mm in 29 cases,and shorter than 1.5cmin 46 cases.During the operation,left subclavian artery revascularization was per formed to patient,whose left vertebral artery was advantage and needs to be fully or partially covered From the second day after operation,asprin was given to patint,whose left subclavian artery was fully or partially coverd by endovascular stent-graft(no endoleak and residual distal tear).Early anticoagulant therapy lasted 3 months.The symptoms or signs about nervous system were observed in the early stage of postoperation,and the CTA was examined at postoperative 3 months.Results The operation succeeded in 75 patients.The diameters of aortic stent were 26mm to 46rmm[ mean(34.3±4.0) mm ].Left subclavian ar tery revascularization was carried out for 2 cases of all patients.The left subclavian artery was fully or partially coverd in 58 patients(fully covered in 19 cases,2/3 covered in 15 cases,1/2 covered in 24 cases),and 56 patints(no endoleak and residualdistal tear) were given anticoagulant therapy to prevent vertebral artery thrombosis.2 patients(2.7％)died in the early stage after operation.1 patient died of renal failure,1 patient died of dissection rupture,The duration of hospitalization was 4 to 19 days [ mean (7.9±3.5)days ].No neurological complications occurred in hospital.The follow-up period was 6 to 66 months.1 patient died during the follow-up,1 patient had recurrence of Stanford A type aortic dissection and was cured by ascending aorta and aortic arch replacement,1 patient had recurrence of Stanford B type aortic dissection and was cured by second endovascular stent-graft exclusion.All patients had no neurological complications,such as cerebral infarction and paraplegia.Concluslon Early anticoagulant therapy could safely and effectively prevent the neurological complications (such as cerebral infarction and paraplegia) related to vertebral artery thrombosis for Stanford B type aortic dissection patients whose left subclavian artery was fully or partially coverd by endovascular stent-graft.
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