Massmann Alexander, Kunihara Takashi, Fries Peter, Schneider Günther, Buecker Arno, Schäfers Hans-Joachim
Clinic of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany.
The Cardiovascular Institute, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2014 Dec;148(6):3003-11. doi: 10.1016/j.jtcvs.2014.07.053. Epub 2014 Aug 1.
To retrospectively evaluate the technical feasibility and midterm results of uncovered thoracoabdominal stent placement in complicated acute aortic dissection Stanford type B (cAADB).
Fourteen consecutive patients (3 females; range, 44-71 years) with cAADB who had symptomatic gastrointestinal malperfusion and claudication underwent immediate uncovered stent implantation (diameter, 7-28 mm; length, 40-100 mm) into the true lumen of the thoracoabdominal aorta (n = 23) and visceral arteries (n = 5).
Stenting resulted in elimination of gastrointestinal ischemia and symptoms in 13 of 14 patients; persisting symptoms led to secondary surgical revascularization in only 1 patient. More than 1 stent (≤ 4) was placed in 7 patients (2 celiac, 1 mesenteric, 2 renal, 8 aorto-iliac). Follow-up computed tomographic angiography (CTA) revealed collapse of 4 aortic stents (diameter, 9-25 mm; length, 100 mm) at 1 week in the absence of symptoms. Balloon reexpansion was possible in all 4 stents, but recollapse occurred within 1 month. Despite stent collapse, the patients remained asymptomatic; ultrasonography and CTA documented sufficient perfusion of the visceral arteries in all patients. Follow-up ranged from 6 months to 5 years (average, 2.5 years). Except for the patient who underwent iliacomesenteric bypass for unspecific abdominal pain, no other patient required additional interventional or surgical therapy.
Acute aortic dissection with suspicion of visceral ischemia should prompt for immediate intervention. Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive approach that provided successful relief of acute visceral ischemia and claudication in cAADB. Stent size should be less than the normal aortic diameter to avoid possible stent collapse.
回顾性评估在复杂急性B型主动脉夹层（cAADB）中裸胸主动脉覆膜支架置入术的技术可行性和中期结果。
连续14例cAADB患者（3例女性；年龄范围44 - 71岁），出现有症状的胃肠道灌注不良和跛行，接受了在胸主动脉真腔（n = 23）和内脏动脉（n = 5）立即植入裸支架（直径7 - 28 mm；长度40 - 100 mm）。
支架置入使14例患者中的13例胃肠道缺血和症状消除；仅1例患者持续存在症状并导致二次手术血运重建。7例患者（2例腹腔干、1例肠系膜、2例肾动脉、8例主动脉 - 髂动脉）置入了超过1枚（≤ 4枚）支架。随访计算机断层血管造影（CTA）显示4枚主动脉支架（直径9 - 25 mm；长度100 mm）在1周时无症状情况下塌陷。所有4枚支架均可行球囊再扩张，但在1个月内再次塌陷。尽管支架塌陷，但患者仍无症状；超声和CTA记录所有患者内脏动脉灌注充足。随访时间为6个月至5年（平均2.5年）。除因不明原因腹痛接受髂 - 肠系膜旁路手术的患者外，无其他患者需要额外的介入或手术治疗。
怀疑有内脏缺血的急性主动脉夹层应立即进行干预。胸主动脉裸支架置入术是一种技术可行且有效的微创方法，可成功缓解cAADB中的急性内脏缺血和跛行。支架尺寸应小于正常主动脉直径以避免可能的支架塌陷。
