2025 年第 4 期 第 20 卷

裸支架联合主动脉腔内修复术治疗降主动脉远端夹层的效果分析

Analysis of the effect of bare stent combined with endovascular aortic repair in the treatment of distal descending aortic dissection

作者：向朝虎胡凯王浩严雨郑天谢艳赖应龙刘勇

英文作者：Xiang Chaohu Hu Kai Wang Hao Yan Yu Zheng Tian Xie Yan Lai Yinglong Liu Yong

单位：川北医学院附属医院心脏大血管外科，南充637000

英文单位：Cardiovascular and Vascular Surgery Affiliated Hospital of North Sichuan Medical College Nanchong 637000 China

关键词：主动脉夹层；裸支架；主动脉腔内修复术；主动脉重塑

英文关键词：Aorticdissection；Barestents；Endovascularaorticrepair；Aorticremodeling

• 摘要：

• 目的 探讨裸支架联合主动脉腔内修复术治疗降主动脉远端夹层的效果。方法 选取川北医学院附属医院心脏大血管外科于2023年4月至2024年4月采用裸支架联合主动脉腔内修复术治疗的6例患者，其中4例患者为Stanford B型主动脉夹层，2例患者为Stanford A型主动脉夹层术后处理远端残余夹层，6例患者夹层均累及胸腹主动脉段，真腔塌陷明显，部分伴有远端脏器灌注不良。回顾性总结患者临床资料。分析裸支架联合主动脉腔内修复术处理降主动脉远端夹层的方法、术后并发症和干预前后降主动脉远端血管重塑情况等。结果 6例患者均成功完成手术，手术时间（113±28）min，无围手术期死亡。3例Stanford B型夹层均置入覆膜支架及金属裸支架各1枚；1例术前诊断为主动脉根部瘤合并B型主动脉夹层患者置入Fabulous支架系统；2例Stanford A型主动脉夹层术后患者中，1例患者在一期术中支架远端续接裸支架1枚，1例患者置入覆膜支架及金属裸支架各1枚，无内漏、支架移位。随访CT血管造影显示，术后降主动脉最大直径较术前明显减小，假腔与真腔之比较术前明显降低，差异均有统计学意义（均P＜0.05）。降主动脉远端真腔扩张明显，血管重塑效果满意，远端脏器灌注不良恢复。结论 应用裸支架联合主动脉腔内修复术处理降主动脉远端夹层安全可行，患者降主动脉远端血管重塑的效果良好，可有效改善远端脏器灌注不良，且可降低术后不良事件发生率，早期随访疗效满意。

• Objective To investigate the efficacy of bare metal stent combined with endovascular aortic repair in the treatment of distal descending aortic dissection. Methods Six patients who underwent bare metal stent combined with endovascular aortic repair in the Department of Cardiovascular and Vascular Surgery, Affiliated Hospital of North Sichuan Medical College from April 2023 to April 2024 were selected. Among them, 4 patients were Stanford type B aortic dissection, and 2 patients were Stanford type A aortic dissection treated after operation. All the 6 patients had thoracoabdominal aortic dissection, with obvious collapse of true lumen and malperfusion of distal organs. The clinical data of the patients were retrospectively analyzed. Methods , postoperative complications and vascular remodeling of distal descending aorta before and after bare-metal stent combined with endovascular aortic repair were analyzed. Results The operation was successfully completed in all 6 patients. The operation time was (113±28) min. There was no perioperative death. Three patients with Stanford type B dissection were treated with 1 covered stent and 1 bare metal stent. One patient diagnosed as aortic root aneurysm with type B aortic dissection was implanted with Fabulous stent system. In the 2 patients with Stanford type A aortic dissection, 1 bare stent was reattached to the distal end of the stent during the first stage operation, and 1 covered stent and 1 bare metal stent were implanted in the other patient, without endoleak and stent migration. Follow-up CT angiography showed that the maximum diameter of the descending aorta was significantly decreased after operation, and the ratio of false lumen to true lumen was significantly decreased after operation (both P＜0.05). The true lumen of the distal descending aorta was dilated obviously, the vascular remodeling effect was satisfactory, and the poor perfusion of the distal organs was recovered. Conclusion Bare-metal stent combined with endovascular aortic repair is safe and feasible for the treatment of distal descending aortic dissection. The effect of vascular remodeling of the distal descending aorta is good, and it can effectively improve the distal organ malperfusion and reduce the incidence of postoperative adverse events. The early follow-up results are satisfactory.