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Clinical Study on Endovascular Graft Exclusion in Treatment of Aortic Dissection

Author: GuoFeiJie
Tutor: GuoDeHe
School: Ningxia Medical University
Course: Surgery
Keywords: Aortic dissection Endovascular graft exclusion Stand
CLC: R654.3
Type: Master's thesis
Year: 2010
Downloads: 47
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Abstract

Objective To investigate the stent graft endovascular graft exclusion (Endovascular Graft Exclusion, EVGE) the methods and results of the treatment of aortic dissection (Aortic Dissection, AD), and the near and medium-term follow-up results were analyzed. Methods 121 cases (male 98, female 23 cases, aged 28 to 83 years old) aortic dissection endovascular graft exclusion of patients with clinical data were retrospectively analyzed. Preoperative CT angiography (Computerized Tomography Angiography, CTA), transthoracic echocardiography TEE (Transthoracic Echocardiography TTE), and magnetic resonance angiography MRA (Magnetic Resonance Angiography, MRA) and other technical assessment of aortic dissection. Endovascular graft exclusion by the left brachial artery into the gold standard pigtail catheter, the aortic angiography understand the breach position and dissection involving the range, and measure the distance between the opening of the first break from the left subclavian artery, true and false lumen diameter, stent grafts. Monitoring of digital subtraction angiography (Digital Subtraction Angiography, DSA) stent graft (the Stent Graft SG) through the femoral artery into the descending thoracic aorta closed dissection. Result of sudden chest and back tear-like pain in 88 cases (72.73%) is the main clinical manifestations of the onset of hypertension, 114 cases (94.21%). The false lumen of aortic dissection involving the abdominal aorta 101 cases (83.47%), involving the renal artery in 79 cases (65.29%). 121 cases of successful implementation of the endovascular graft exclusion of aortic dissection, Stanford B type 116 cases, five cases of Stanford type A. Of bracket 124, including three cases of the two stents; seven cases Cuff; the routine bow vascular bypass; the three cases arterial ductus occluder (Patent Ductus Arteriosus Occlusion, PDAO) closure the left subclavian artery in 24 patients with stent grafts direct closure of the left subclavian artery (Left subclavian Artery LSA). Surgery in 18 cases (14.88%) of internal leakage, endoleaks disappeared or significantly reduced by the corresponding treatment. The postoperative aortic angiography sandwich break completely closed. Were no transit thoracotomy. The risk factors of age, history of hypertension, dissecting aneurysm neck diameter, the first break from the left subclavian artery distance by Logistics multi-factor regression analysis suggest that the acute phase of surgery, patients with multiple organ failure, Endovascular The aortic dissection Wai independent risk factors for operative mortality. The patients were followed up for 1 to 48 months, 8 deaths, respectively, in the first month (4), 2 (2), 3 months (2 cases) death. 4 cases died of multiple organ dysfunction syndrome, 2 patients died of aortic dissection, 1 patient died of liver cancer, one cases the cause of death is unknown. Full set of rows CTA review, after 3 months, all patients with aortic dissection near the side of the false lumen of the left subclavian artery is no longer developing, the gradual expansion of the descending thoracic aortic true lumen, false lumen thrombosis of the proximal stent position, shape good. After 2 weeks, 1 case of ascending aortic dissection (no new break, aorta see the contrast agent from the primary first break retrograde into the ascending aorta), a proximal stent placement false lumen disappeared after a stent graft. 1-year review of the whole group of patients with aortic CTA proximal false lumen no lesions, some patients remote visible the limitations of the stable existence of the false lumen. Conclusion Hypertension is the leading cause of morbidity of aortic dissection, the vast majority of Stanford type B aortic dissection involving the abdominal aorta. Multi-row spiral CT technology is an effective means of diagnosis of aortic dissection. Acute phase line endovascular graft exclusion for aortic dissection around an independent risk factor for operative mortality. For the proximal aortic dissection riveting area patients, preoperative, intraoperative accurate examination, the most direct use of stent grafts and then complete the closure of the left subclavian artery surgery. The most common complication of surgery is internal leakage, after proper treatment, most within the drain can be effectively treated in interventional procedures. The patients were followed up for the majority of cases the false lumen disappeared without endoleaks, stent position, normal morphology. A small number of cases continued presence of blood flow distal false lumen, but regular follow-up prompts distal false lumen form stable, there is no tendency to expand. Stent graft endovascular graft exclusion is a safe and effective method of treatment of aortic dissection, the near and medium-term efficacy. Operative mortality and low complication rate, high success rate of surgery and survival rates.

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