血管腔内处理Stanford B型主动脉夹层内脏动脉区裂口策略
|
摘要
胸主动脉腔内修复术(TEVAR)是目前Stanford B型主动脉夹层常规治疗方法。治疗中通常只隔绝原发裂口,即所谓近端裂口,而对远端裂口较少实施干预。随着对夹层术后主动脉重塑进一步深入研究,研究者们发现术后25%~40%患者出现远端扩张,需再干预处理。其中腹主动脉内脏分支区裂口处理涉及重要脏器血供,治疗上存在一定特殊性。本文结合国内外研究进展,就腹主动脉内脏分支区夹层裂口常用处理方法作一综述。
At present, thoracic endovascular aortic repair(TEVAR) is the routine treatment for Stanford type B aortic dissection. Usually, during the interventional treatment only the primary entry tear, i.e.so-called proximal entry tear, is to be isolated with a stent-graft, while less intervention is adopted for the distal entry tear. With the deepening of research concerning aortic remodeling after TEVAR, the researchers have found that 25%-50% of patients will develop aneurysmal dilation at the distal end of dissected aorta,which needs to be treated again. Among them, the treatment of entry tear at visceral branch area of the abdominal aorta has a certain degree of difficulty and technical particularity as the interventional management may affect the blood supply of vital organs. Referring to the research progress at home and abroad, this article aims to make a review about the common therapeutic methods for the entry tear at visceral branch area of the abdominal aorta.
At present, thoracic endovascular aortic repair(TEVAR) is the routine treatment for Stanford type B aortic dissection. Usually, during the interventional treatment only the primary entry tear, i.e.so-called proximal entry tear, is to be isolated with a stent-graft, while less intervention is adopted for the distal entry tear. With the deepening of research concerning aortic remodeling after TEVAR, the researchers have found that 25%-50% of patients will develop aneurysmal dilation at the distal end of dissected aorta,which needs to be treated again. Among them, the treatment of entry tear at visceral branch area of the abdominal aorta has a certain degree of difficulty and technical particularity as the interventional management may affect the blood supply of vital organs. Referring to the research progress at home and abroad, this article aims to make a review about the common therapeutic methods for the entry tear at visceral branch area of the abdominal aorta.
引文
[1]Mody PS,Wang Y,Geirsson A,et al.Trends in aortic dissection hospitalizations,interventions,and outcomes among medicare beneficiaries in the United States,2000-2011[J].Circ Cardiovasc Qual Outcomes,2014,7:920-928.
[2]Sigman MM,Palmer OP,Ham SW,et al.Aortic morphologic findings after thoracic endovascular aortic repair for type B aortic dissection[J].JAMA Surg,2014,149:977-983.
[3]Kolbel T,Tsilimparis N,Wipper S,et al.TEVAR for chronic aortic dissection:is covering the primary entry tear enough?[J].J Cardiovasc Surg(Torino),2014,55:519-527.
[4]Zhu C,Huang B,Zhao J,et al.Influence of distal entry tears in acute type B aortic dissection after thoracic endovascular aortic repair[J].J Vasc Surg,2017,66:375-385.
[5]Debakey ME,Mc Collum CH,Crawford ES,et al.Dissection and dissecting aneurysms of the aorta:twenty-year follow-up of five hundred twenty-seven patients treated surgically[J].Surgery,1982,92:1118-1134.
[6]Trimarchi S,Tsai T,Eagle KA,et al.Acute abdominal aortic dissection:insight from the International Registry of Acute Aortic Dissection(IRAD)[J].J Vasc Surg,2007,46:913-919.
[7]Bockler D,Bianchini Massoni C,Geisbusch P,et al.Singlecenter experience in the management of spontaneous isolated abdominal aortic dissection[J].Langenbecks Arch Surg,2016,401:249-254.
[8]De Rango P.What we can learn from experts and expertise with fenestrated and branched stent grafts:The“croissant-doughnut”concept for post-dissection aneurysm repair[J].Eur J Vasc Endovasc Surg,2016,51:498.
[9]Smith TA,Gatens S,Andres M,et al.Hybrid repair of thoracoabdominal aortic aneurysms involving the visceral vessels:comparative analysis between number of vessels reconstructed,conduit,and gender[J].Ann Vasc Surg,2011,25:64-70.
[10]Quinones-Baldrich W,Jimenez JC,Derubertis B,et al.Combined endovascular and surgical approach(CESA)to thoracoabdominal aortic pathology:a 10-year experience[J].J Vasc Surg,2009,49:1125-1134.
[11]Park JH,Chung JW,Choo IW,et al.Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms:preliminary experience[J].J Vasc Interv Radiol,1996,7:819-823.
[12]Mc Williams RG,Fearn SJ,Harris PL,et al.Retrograde fenestration of endoluminal grafts from target vessels:feasibility,technique,and potential usage[J].J Endovasc Ther,2003,10:946-952.
[13]Murphy EH,Dimaio JM,Dean W,et al.Endovascular repair of acute traumatic thoracic aortic transection with laser-assisted in-situ fenestration of a stent-graft covering the left subclavian artery[J].J Endovasc Ther,2009,16:457-463.
[14]Crawford SA,Sanford RM,Forbes TL,et al.Clinical outcomes and material properties of in situ fenestration of endovascular stent grafts[J].J Vasc Surg,2016,64:244-250.
[15]Oikonomou K,Kopp R,Katsargyris A,et al.Outcomes of fenestrated/branched endografting in post-dissection thoracoabdominal aortic aneurysms[J].Eur J Vasc Endovasc Surg,2014,48:641-648.
[16]Haulon S,Fabre D,Sobocinski J,et al,Commentary:endovascular repair of postdissection aneurysms involving the thoracoabdominal Aorta[J].J Endovasc Ther,2017,24:112-114.
[17]张宏鹏,郭伟,鲁通,等.烟囱技术结合逆向分支技术治疗腹主动脉瘤一例[J].中华外科杂志,2016,54:639-640.
[18]Gehringhoff B,Torsello G,Pitoulias GA,et al.Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches[J].J Endovasc Ther,2011,18:650-655.
[19]Coscas R,Kobeiter H,Desgranges P,et al.Technical aspects,current indications,and results of chimney grafts for juxtarenal aortic aneurysms[J].J Vasc Surg,2011,53:1520-1527.
[20]Adovasio R,Chiarandini S,Calvagna C,et al.Treatment of complex abdominal aortic aneurysms with parallel graftendovascular aneurysm repair.Retrospective analysis of a single center experience and midterm results[J].Ann Vasc Surg,2017,pii:S0890-5096(16)31294-31298.
[21]Li Y,Hu Z,Bai C,et al.Fenestrated and chimney technique for juxtarenal aortic aneurysm:a systematic review and pooled data analysis[J].Sci Rep,2016,6:20497.
[22]Loubert MC,van Der Hulst VP,De Vries C,et al.How to exclude the dilated false lumen in patients after a type B aortic dissection?The Cork in the bottleneck[J].J Endovasc Ther,2003,10:244-248.
[23]赵珺,尤庆生,张玉春,等.封堵器联合裸支架治疗破口位于腹腔分支动脉区域的主动脉夹层[J].中华外科杂志,2013,51:796-799.
[24]俞旭华,冯家煊,陆清声,等.主动脉疾病的封堵器治疗[J].中国血管外科杂志·电子版,2013,5:189-192.
[25]Noda Y,Kato N,Tanaka S,et al.Migration of a false lumen occluder in a patient with chronic aortic dissection[J].Cardiovasc Intervent Radiol,2017,40:1807-1808.
[26]Hu J,Yang J.Atrial septal defect occluder for the distal re-entry tear in type B aortic dissection[J].Int J Cardiol,2014,176:e70-e72.
[27]Henry M,Polydorou A,Frid N,et al.Treatment of renal artery aneurysm with the multilayer stent[J].J Endovasc Ther,2008,15:231-236.
[28]Chocron S,Vaislic C,Kaili D,et al.Multilayer stents in the treatment of thoraco-abdominal residual type B dissection[J].Interact Cardiovasc Thorac Surg,2011,12:1057-1059.
[29]Hofferberth SC,Nixon IK,Mossop PJ.Aortic false lumen thrombosis induction by embolotherapy(AFTER)following endovascular repair of aortic dissection[J].J Endovasc Ther,2012,19:538-545.
[30]Lu Q,Chen Y,Zhang Y,et al.Endovascular treatment of distal tears located in the reno-visceral segment with bare-metal stents and coils in a complicated type B aortic dissection[J].Ann Vasc Surg,2017,45:264.e5-264.e8.
[31]Bel A,Alsac JM,Baissas V,et al.Spot stenting of the tear in type B aortic dissection[J].Ann Vasc Surg,2013,27:671.e1-671.e6.
[32]赵珺.Stanford B型主动脉夹层远端裂口的微创治疗方案[J].中国胸心血管外科临床杂志,2014,21:279-286.
[33]谷涌泉,郭连瑞,郭建明,等.胸主动脉覆膜支架联合八爪鱼技术腔内修复复杂胸腹主动脉瘤[J].介入放射学杂志,2016,25:487-490.
[34]Anderson J,Remund T,Pohlson K,et al.Description of a new technique for repairing chronic type B dissections that involve visceral branches being fed by both true and false lumen by using both lumens as conduits[J].Vascular,2016,24:103-105.
[35]Xiong J,Ge Y,Liu X,et al.Use of the Octopus endograft technique to reconstruct renovisceral arteries arising from the false lumen of a rapidly expanding type B aortic dissection after endovascular repair[J].J Endovasc Ther,2017,24:107-111.
[2]Sigman MM,Palmer OP,Ham SW,et al.Aortic morphologic findings after thoracic endovascular aortic repair for type B aortic dissection[J].JAMA Surg,2014,149:977-983.
[3]Kolbel T,Tsilimparis N,Wipper S,et al.TEVAR for chronic aortic dissection:is covering the primary entry tear enough?[J].J Cardiovasc Surg(Torino),2014,55:519-527.
[4]Zhu C,Huang B,Zhao J,et al.Influence of distal entry tears in acute type B aortic dissection after thoracic endovascular aortic repair[J].J Vasc Surg,2017,66:375-385.
[5]Debakey ME,Mc Collum CH,Crawford ES,et al.Dissection and dissecting aneurysms of the aorta:twenty-year follow-up of five hundred twenty-seven patients treated surgically[J].Surgery,1982,92:1118-1134.
[6]Trimarchi S,Tsai T,Eagle KA,et al.Acute abdominal aortic dissection:insight from the International Registry of Acute Aortic Dissection(IRAD)[J].J Vasc Surg,2007,46:913-919.
[7]Bockler D,Bianchini Massoni C,Geisbusch P,et al.Singlecenter experience in the management of spontaneous isolated abdominal aortic dissection[J].Langenbecks Arch Surg,2016,401:249-254.
[8]De Rango P.What we can learn from experts and expertise with fenestrated and branched stent grafts:The“croissant-doughnut”concept for post-dissection aneurysm repair[J].Eur J Vasc Endovasc Surg,2016,51:498.
[9]Smith TA,Gatens S,Andres M,et al.Hybrid repair of thoracoabdominal aortic aneurysms involving the visceral vessels:comparative analysis between number of vessels reconstructed,conduit,and gender[J].Ann Vasc Surg,2011,25:64-70.
[10]Quinones-Baldrich W,Jimenez JC,Derubertis B,et al.Combined endovascular and surgical approach(CESA)to thoracoabdominal aortic pathology:a 10-year experience[J].J Vasc Surg,2009,49:1125-1134.
[11]Park JH,Chung JW,Choo IW,et al.Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms:preliminary experience[J].J Vasc Interv Radiol,1996,7:819-823.
[12]Mc Williams RG,Fearn SJ,Harris PL,et al.Retrograde fenestration of endoluminal grafts from target vessels:feasibility,technique,and potential usage[J].J Endovasc Ther,2003,10:946-952.
[13]Murphy EH,Dimaio JM,Dean W,et al.Endovascular repair of acute traumatic thoracic aortic transection with laser-assisted in-situ fenestration of a stent-graft covering the left subclavian artery[J].J Endovasc Ther,2009,16:457-463.
[14]Crawford SA,Sanford RM,Forbes TL,et al.Clinical outcomes and material properties of in situ fenestration of endovascular stent grafts[J].J Vasc Surg,2016,64:244-250.
[15]Oikonomou K,Kopp R,Katsargyris A,et al.Outcomes of fenestrated/branched endografting in post-dissection thoracoabdominal aortic aneurysms[J].Eur J Vasc Endovasc Surg,2014,48:641-648.
[16]Haulon S,Fabre D,Sobocinski J,et al,Commentary:endovascular repair of postdissection aneurysms involving the thoracoabdominal Aorta[J].J Endovasc Ther,2017,24:112-114.
[17]张宏鹏,郭伟,鲁通,等.烟囱技术结合逆向分支技术治疗腹主动脉瘤一例[J].中华外科杂志,2016,54:639-640.
[18]Gehringhoff B,Torsello G,Pitoulias GA,et al.Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches[J].J Endovasc Ther,2011,18:650-655.
[19]Coscas R,Kobeiter H,Desgranges P,et al.Technical aspects,current indications,and results of chimney grafts for juxtarenal aortic aneurysms[J].J Vasc Surg,2011,53:1520-1527.
[20]Adovasio R,Chiarandini S,Calvagna C,et al.Treatment of complex abdominal aortic aneurysms with parallel graftendovascular aneurysm repair.Retrospective analysis of a single center experience and midterm results[J].Ann Vasc Surg,2017,pii:S0890-5096(16)31294-31298.
[21]Li Y,Hu Z,Bai C,et al.Fenestrated and chimney technique for juxtarenal aortic aneurysm:a systematic review and pooled data analysis[J].Sci Rep,2016,6:20497.
[22]Loubert MC,van Der Hulst VP,De Vries C,et al.How to exclude the dilated false lumen in patients after a type B aortic dissection?The Cork in the bottleneck[J].J Endovasc Ther,2003,10:244-248.
[23]赵珺,尤庆生,张玉春,等.封堵器联合裸支架治疗破口位于腹腔分支动脉区域的主动脉夹层[J].中华外科杂志,2013,51:796-799.
[24]俞旭华,冯家煊,陆清声,等.主动脉疾病的封堵器治疗[J].中国血管外科杂志·电子版,2013,5:189-192.
[25]Noda Y,Kato N,Tanaka S,et al.Migration of a false lumen occluder in a patient with chronic aortic dissection[J].Cardiovasc Intervent Radiol,2017,40:1807-1808.
[26]Hu J,Yang J.Atrial septal defect occluder for the distal re-entry tear in type B aortic dissection[J].Int J Cardiol,2014,176:e70-e72.
[27]Henry M,Polydorou A,Frid N,et al.Treatment of renal artery aneurysm with the multilayer stent[J].J Endovasc Ther,2008,15:231-236.
[28]Chocron S,Vaislic C,Kaili D,et al.Multilayer stents in the treatment of thoraco-abdominal residual type B dissection[J].Interact Cardiovasc Thorac Surg,2011,12:1057-1059.
[29]Hofferberth SC,Nixon IK,Mossop PJ.Aortic false lumen thrombosis induction by embolotherapy(AFTER)following endovascular repair of aortic dissection[J].J Endovasc Ther,2012,19:538-545.
[30]Lu Q,Chen Y,Zhang Y,et al.Endovascular treatment of distal tears located in the reno-visceral segment with bare-metal stents and coils in a complicated type B aortic dissection[J].Ann Vasc Surg,2017,45:264.e5-264.e8.
[31]Bel A,Alsac JM,Baissas V,et al.Spot stenting of the tear in type B aortic dissection[J].Ann Vasc Surg,2013,27:671.e1-671.e6.
[32]赵珺.Stanford B型主动脉夹层远端裂口的微创治疗方案[J].中国胸心血管外科临床杂志,2014,21:279-286.
[33]谷涌泉,郭连瑞,郭建明,等.胸主动脉覆膜支架联合八爪鱼技术腔内修复复杂胸腹主动脉瘤[J].介入放射学杂志,2016,25:487-490.
[34]Anderson J,Remund T,Pohlson K,et al.Description of a new technique for repairing chronic type B dissections that involve visceral branches being fed by both true and false lumen by using both lumens as conduits[J].Vascular,2016,24:103-105.
[35]Xiong J,Ge Y,Liu X,et al.Use of the Octopus endograft technique to reconstruct renovisceral arteries arising from the false lumen of a rapidly expanding type B aortic dissection after endovascular repair[J].J Endovasc Ther,2017,24:107-111.