Botsios S, Schuermann K, Maatz W, Keck N, Walterbusch G
Department of Thoracic- and Cardiovascular Surgery, St.-Johannes Hospital Dortmund, and Institute for Heart and Circulation Research, University Witten/Herdecke, Dortmund, Germany.
Thorac Cardiovasc Surg. 2010 Aug;58(5):280-4. doi: 10.1055/s-0030-1249942. Epub 2010 Aug 2.
Complicated acute type B dissections treated surgically carry a high risk of mortality. Endovascular interventions with stent-graft prostheses are a less invasive alternative and may obviate the need for surgery in most cases. We report here on our five years' experience with endovascular stenting in complicated acute type B dissections.
Between March 2001 and January 2006, 32 patients (27 males, 5 females) with a mean age of 61.4+/-11.32 years (range 29-80) underwent stent grafting for complicated acute type B dissections. Indications were progression of dissection with impending rupture (n=10), uncontrollable hypertension (n=9), intractable thoracic pain (n=7), and malperfusion syndrome (n=6). Talent-Medtronic (n=34) and Excluder-Gore (n=3) stent-grafts were used. In 5 patients two stents were necessary. In addition to stent grafting, aortic fenestration was performed in all three cases with lower limb ischemia.
Endovascular stent placement was successful in all patients. Hospital mortality was 9.3% (3/32). No deaths occurred during follow-up (mean 32 months).
Endovascular stenting of complicated acute type B dissections represents a safe alternative to surgery. Endovascular stent-grafts of appropriate sizes should be readily available in the hospital for emergency use, thus avoiding delays in treatment.
手术治疗复杂急性B型主动脉夹层死亡率高。血管内支架植入术是一种侵入性较小的替代方法，在大多数情况下可能无需进行手术。我们在此报告我们在复杂急性B型主动脉夹层血管内支架置入方面的五年经验。
2001年3月至2006年1月，32例患者（男27例，女5例）接受了复杂急性B型主动脉夹层支架植入术，平均年龄61.4±11.32岁（范围29 - 80岁）。手术指征包括夹层进展伴即将破裂（n = 10）、难以控制的高血压（n = 9）、顽固性胸痛（n = 7）和灌注不良综合征（n = 6）。使用了美敦力公司的Talent支架（n = 34）和戈尔公司的Excluder支架（n = 3）。5例患者需要植入两枚支架。除了支架植入外，所有3例下肢缺血患者均进行了主动脉开窗术。
所有患者血管内支架置入均成功。住院死亡率为9.3%（3/32）。随访期间（平均32个月）无死亡病例。
复杂急性B型主动脉夹层血管内支架置入是一种安全的手术替代方法。医院应备有合适尺寸的血管内支架，以便紧急使用，从而避免治疗延误。
