CAJ | 학술논문

目的探讨术前定位脊髓跟大动脉(AKA)对主动脉夹层腔内治疗结果的影响.方法选取2005年3月至2011年9月,中山大学附属第五医院(43例)和复旦大学附属中山医院(174例)共217例因胸主动脉夹层而接受腔内修补手术的患者,男143例,女74例,平均年龄(65±11)岁.依据术前CT动脉造影是否明确定位AKA将其分为两组.记录术中支架移植物的远端锚定水平及术后假腔血栓形成情况.结果 121例(55.8％)患者(A组)术前明确定位AKA,96例(44.2％)患者(B组)未能明确定位.A组患者主动脉获得了较长的支架覆盖范围,其远端锚定区达T8-T10者显著多于B组(59.5％比12.5％,x2=49.85,P＜0.01).而且,平均7.3个月的随访结果表明,A组假腔完全血栓形成的比例也显著高于B组(32.1％比19.1％,x2 =4.34,P＜0.05).结论主动脉夹层腔内修补时,扩展支架移植物的锚定范围,可促进假腔血栓化和主动脉重塑.
목적 탐토술전정위척수근대동맥(AKA)대주동맥협층강내치료결과적영향.방법 선취2005년3월지2011년9월,중산대학부속제오의원(43례)화복단대학부속중산의원(174례)공217례인흉주동맥협층이접수강내수보수술적환자,남143례,녀74례,평균년령(65±11)세.의거술전CT동맥조영시부명학정위AKA장기분위량조.기록술중지가이식물적원단묘정수평급술후가강혈전형성정황.결과 121례(55.8％)환자(A조)술전명학정위AKA,96례(44.2％)환자(B조)미능명학정위.A조환자주동맥획득료교장적지가복개범위,기원단묘정구체T8-T10자현저다우B조(59.5％비12.5％,x2=49.85,P＜0.01).이차,평균7.3개월적수방결과표명,A조가강완전혈전형성적비례야현저고우B조(32.1％비19.1％,x2 =4.34,P＜0.05).결론 주동맥협층강내수보시,확전지가이식물적묘정범위,가촉진가강혈전화화주동맥중소.
Objective To evaluate the effects of using longer endografts in conjunctions with the location of Adamkiewicz artery (AKA) on midterm outcomes of endovascular treatment for thoracic aortic dissection.Methods From March 2005 to September 2011,217 patients with type B dissection were recruited.There were 143 males and 74 females with a mean age of 65 ± 11 years.Among them,43 patients were from Fifth Affiliated Hospital of Sun Yat-Sen University while another 174 patients from Affiliated Zhongshan Hospital of Fudan University.They were divided into 2 groups according to whether AKA was identified or not pre-operatively.Endovascular repairs were performed for all patients.Distal landing levels of endograft were recorded.The thrombosis of false lumen and the complications of spinal cord injury and endoleak were analyzed.Results AKA was detected in 121 (55.8％) patients (group A) but not in 96 (44.2％) patients (group B).According to the levels of AKA,the patients of group A obtained the stabilization of affected thoracic aorta over a longer distance.And the ratio of patients with distal landing levels at T8-T10 was significantly higher than in group B (59.5％ vs 12.5％,x2 =49.85,P ＜0.01).Also,during the follow-up period of 7.3 months,the ratio of patients with total thrombosis of false lumen in group A was significantly higher than that in group B (32.1％ vs 19.1％,x2 =4.34,P ＜0.05).Conclusion During the endovascular repair of thoracic aortic dissection,selecting a longer device may provide a better structural stability of affected aorta and promote false lumen thrombosis.