Percutaneous management of ischemic complications in patients with type-B aortic dissection
Percutaneous management of ischemic complications in patients with type-B aortic dissection
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DOI：
10.1097/01.rvi.0000058320.82956.3f
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发表时间：
2003-02-01
影响因子：
2.9
通讯作者：
Sicard, GA
中科院分区：
文献类型：
--
作者：
Vedantham, S;Picus, D;Sicard, GA
目的：总结应用经皮方法处理B型主动脉夹层的缺血性并发症的经验。材料与方法：回顾我们的介入放射学数据库，11例急性B型主动脉夹层患者接受了13次血管内手术，试图对23个缺血血管区域(4个肠系膜、11个肾脏、8个肢体)进行血运重建。经皮介入治疗包括球囊开窗术(4例)、主动脉真腔支架置入术(3例)和分支血管支架置入术(8例)。结果：23个血管区域中有21个血管首次再通成功(91%)，无30d死亡、住院死亡和截瘫。另有一名患者成功地接受了初步治疗，采用介入/手术相结合的方法对缺血肢体进行再灌流。1例患者在支架置入过程中发生肾动脉夹层急性血栓形成。两名患者的主动脉真腔塌陷增加后导致进一步的缺血。在随访期间(平均16个月)，没有患者有假性管腔扩大或晚期复发缺血的证据。结论：腔内方法为急性复杂B型主动脉夹层患者提供了一种发病率较低的非手术治疗方案。
PURPOSE: To review our experience with the use of percutaneous methods to manage the ischemic complications of type-B aortic dissection.MATERIALS AND METHODS: Retrospective review of our interventional radiology database identified 11 patients with acute type-B aortic dissection who underwent 13 endovascular procedures to attempt revascularization of 23 ischemic vascular territories (four mesenteric, 11 renal, eight lower extremities). Percutaneous interventions included balloon fenestration (four patients), aortic true lumen stent placement (three patients), and branch vessel stent placement (eight patients).RESULTS: Successful initial reperfusion of 21 of 23 vascular territories (91%) was achieved with use of percutaneous methods alone, with no 30-day mortality, in-hospital mortality, or paraplegia. One additional patient underwent successful initial treatment with use of a combined interventional/surgical approach to reperfuse an ischemic limb. One patient developed acute thrombosis of a dissected renal artery during stent placement. Increased aortic true lumen collapse later resulted in further ischemia in two patients. During follow-up (mean, 16 mo), no patient has had evidence of false lumen enlargement or late recurrent ischemia.CONCLUSION: Endovascular methods offer a less-morbid nonsurgical treatment alternative for patients with acute complicated type-B aortic dissection.