Repair of the thoracic aorta by transaortic stent grafting (open stenting).
Repair of the thoracic aorta by transaortic stent grafting (open stenting).
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通过经主动脉支架移植术（开放式支架置入术）修复胸主动脉。
DOI：
10.1016/s0003-4975(01)03381-1
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
Tatsuaki Sumiyoshi
中科院分区：
文献类型：
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作者：
N. Uchida;H. Ishihara;M. Sakashita;M. Kanou;Tatsuaki Sumiyoshi
方法1997年9月至2000年12月，19例主动脉弓远端胸动脉瘤（TAA）患者在颈动脉旁路下接受了开放式主动脉弓支架移植术。对21例斯坦福大学A型急性主动脉夹层患者行开放式支架植入术和全主动脉弓置换术，7例斯坦福大学B型慢性主动脉夹层患者行颈动脉旁路支架植入术。TAA为11%，A型夹层为10%，B型夹层为0%。尽管TAA或A型夹层均不需要胸主动脉二次手术，但1例TAA患者在术后6个月突然主动脉破裂后死亡，1例B型患者在术后11个月因覆膜支架引起的溃疡需要降主动脉置换术。在随访计算机断层扫描中，在TAA患者中，覆膜支架排除的真实动脉瘤显示早期血栓形成，但血栓形成的动脉瘤在术后1 - 6个月开始吸收，并逐渐进展。在B型慢性夹层的患者中，假腔显示早期血栓形成，真腔在移植物的中心部分扩张，这可能通过与支架的相互作用而增加湍流。在A型急性夹层患者中，假腔显示早期血栓形成和早期absorbtion.ConclusionsEarly和晚期结果的开放支架术是可以接受的，后续的计算机断层扫描可能能够预测开放支架术的晚期结果。
BackgroundThe late results of direct open stent grafting of the aortic arch for aortic arch repair have not been reported previously.MethodsBetween September 1997 and December 2000, 19 patients underwent open stent grafting with carotid artery bypass for thoracic arteriosclerotic aneurysms (TAA) of the distal aortic arch. In addition, 21 patients underwent open stent grafting with total aortic arch replacement for Stanford type A acute aortic dissection and 7 patients underwent stenting with carotid bypass for Stanford type B chronic aortic dissection.ResultsThe early mortality rate was 11% for TAA, 10% for type A dissection, and 0% for type B dissection. Whereas none of the TAA or type A dissection required a second operation on the thoracic aorta, 1 TAA patient died 6 months postoperatively after sudden aortic rupture and 1 type B patient required descending aortic replacement because of ulceration caused by the stent graft at 11 months postoperatively. On follow-up computed tomography scan, in TAA patients, true aneurysms excluded by the stent graft showed early thrombosis, but the absorption of thrombosed aneurysms started from 1 to 6 months postoperatively and gradually progressed. In patients with type B chronic dissection, the false lumen showed early thrombosis and the true lumen was dilated at the central portion of the graft, which might increase turbulent flow by interaction with the stent. In patients with type A acute dissection, the false lumen showed both early thrombosis and early absorption.ConclusionsEarly and late results of open stenting are acceptable and follow-up computed tomography scan may be able to predict late results of open stenting.