血管腔内治疗B型胸主动脉夹层伴A型壁内血肿3例.docxVIP

血管腔内治疗B型胸主动脉夹层伴A型 壁内血肿3例 宋松林熊斌 郑传胜阚雪锋 钱坤 冯敢生 华中科技大学同济医学院附属协和医院放射科 摘要： 目的 探讨胸主动脉腔内修复术(TEVAR)治疗Standford B型夹层伴A型壁内血 肿(MH)的安全性及有效性。方法2015年10月至2017年1月共收治3例B型 夹层伴A型MH患者，入院后稳定血压、心率，对症保守治疗14 d后行TEVAR 术。结果3例患者均顺利完成TEVAR术，无逆撕等并发症。术后1个月全主动 脉CTA复查显示夹层破口完全封闭，无内漏发生，真腔血流明显改善，壁内血 肿明显吸收消退，升主动脉管壁厚度恢复至正常水平;患者临床症状明显好转， 无截瘫、死亡等严重并发症发生。结论 对伴发升主动脉MH的Stanclforcl B型胸 主动脉夹层，如果升主动脉内膜完整，降压、降心率处理后症状缓解，在发病 M d后行TEVAR术是安全有效的。 关键词： 胸主动脉腔内修复术;Standford B型胸主动脉夹层;A型壁内血肿; 作者简介：熊斌 E-ina订:herrxiong@126. com 收稿日期：2017-01-31 Endovascular repair of Standford type B thoracic aortic dissection complicated by type A intramural hematoma: preliminary resuIts in 3 pa/tients SONG Songlin XIONG Bin ZHENG Chuansheng KAN Xuefeng QIAN Kun FENG Gansheng Depar tment ofRadiology, Union Hosp it al, Tongji Medical College, Huazhong University of Science and Technology; Abstract： Objective To evaluate the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) in treeiting Stemdford type B thoracic aor tic disscc tion complica ted by type A int ramural hema to ma. Met hods From October 2015 to January 2017, a total of 3 patients with Standford type B thoracic aortic dissection complicated by type A intramural hematoma were admitted to authors hospital to receive treatment. After admission, conservative treatment such as stabi 1 izing blood pressure and heart rate, symptomatic medication, etc. were carried out for 14 days, then, TEVAR was performed. ResuIts Successful TEVAR was accomplished in all 3 patients, no serious complications, such as reverse tear, occurred. One month after TEVAR, reexamination of total aortic CT angiography revealed that the rupture of dissection was completely closed with no internal leakage, the blood flow in the true lumcn was obviously improved, the intramural hematoma was remarkably absorbed and faded away, and the wall thickness of ascending aorta returned to normal range. The clinical symptoms were greatly improved, no serious complications such as paraplegia or death occur