双源CT在StanfordB型主动脉夹层胸主动脉腔内修复术后随访中的应用价值-东南大学学报医学版

双源CT在StanfordB型主动脉夹层胸主动脉腔内修复术后随访中的应用价值

单位：华中科技大学附属武汉市中心医院放射科, 湖北武汉 430010

分类号：R445.3;R459.9;R654.3

出版年·卷·期（页码）：2017·36·第六期（924-928）

摘要：

目的：探讨双源CT在Stanford B型主动脉夹层胸主动脉腔内修复（TEVAR）术后随访中的应用价值。方法：回顾性分析128例TEVAR术后的Stanford B型夹层患者的双源CT血管造影（CTA）资料，对容积再现、最大密度投影、多平面重组图像及原始图像进行综合分析，观察并记录支架位置及形态、支架内血栓形成，是否合并内漏、假腔血栓化，支架远端是否存在新发破口、腹主动脉重要分支开口及血供等情况。结果：128例患者支架、真假腔及并发症均得到清晰显示；检出Ⅰ型内漏10例，Ⅲ型内漏2例，支架内少量血栓形成15例；47例假腔完全血栓化，81例假腔大部分血栓化；支架远端存在新发破口8例；由真腔供血的重要分支血管328支，由真、假腔共同供血的分支血管35支，完全由假腔供血的分支血管40支，其中6例肾动脉充盈不佳，肾实质灌注减少，5例开口于假腔的肠系膜下动脉起始段闭塞。结论：双源CT可准确清晰地显示支架、真假腔及术后并发症，具有无创、超高的时间及空间分辨力、低辐射剂量等独特优势，应作为B型夹层患者TEVAR术后随访的首选检查手段。

Objective: To investigate the application value of dual source CT for the follow-up of the Stanford type B aortic dissection after thoracic endovascular aortic repair.Methods: The dual source CT angiography data of 128 patients with Stanford type B aortic dissection underwent thoracic endovascular aortic repair were retrospectively analyzed. The images of volume rendering, the maximum density projection, the multiplanar reconstructed and the original images were analyzed comprehensively and the observation was focused on the stent location and form, tent thrombosis, internal leakage, false lumen thrombosis, stent distal redissection, the ostium and blood flow of abdominal aorta important branches. Results: The stent, true lumen, false lumen, and complications were clearly demonstrated in all patients; ten cases of Stanford type B aortic dissection with typeⅠ, 2 cases with type Ⅲ internal leakage, and 15 cases of stent thrombosis; 47 cases of complete thrombosis and 81 cases of mostly thrombosed in the false lumen; and 8 cases of stent distal redissection were detected; 328 branches of blood vessels were from the true lumen, 35 branches of blood vessels were supplied by the true and false lumen,and 40 branches of blood vessels were completely from the false lumen, among them, 6 cases had poor renal artery filling, with renal parenchyma decreased perfusion, 5 cases of inferior mesenteric artery were almost no blood flow. Conclusion: Dual source CT can accurately and clearly display stent, true lumen, false lumen and postoperative complications, and with its unique advantages such as non-invasive, ultra high time and space resolution, low radiation dose and so on, dual source CT should be the first choice for the follow-up of Stanford type B dissection after thoracic endovascular aortic repair.

参考文献：

[1] CRIADO F J.Aortic dissection:a 250-year perspective[J].Tex Heart Inst J,2011,38:694-700.
[2] FATTORI R,CAO P,de RANGO P J,et al.Interdisciplinary expert consensus document on management of type B aortic dissection[J].Am Coll Cardiol,2013,61:1661-1678.
[3] CHEMELLI S L,CHEMELLI A,STRASAK A,et al.Endovascular repair or medical treatment of acute type B aortic dissection?A comparison[J].Eur J Radiol,2010,73(1):175-180.
[4] ZOLI S,ETZ C D,RODER F,et al.Long-term survival after open repair of chronic distal aortic dissection[J].Ann Thorac Surg,2010,89(5):1458-1466.
[5] 陈亮,杨剑,刘金成,等.双源CT术前评估胸主动脉夹层破口的对照研究[J].第四军医大学学报,2009,30(10):953-956.
[6] 林婷婷,邓克学.64排螺旋CT血管造影技术在主动脉夹层术前诊断及术后随访中的价值及优越性[J].安徽医科大学学报,2012,47:305-307.
[7] 赵珺.Stanford B型主动脉夹层全程腔内根治性修复术:概念与方案[J].中国血管外科杂志,2016,8(1):16-19.
[8] WHITE R A,MILLER D C,CRIADO F J,et al.Report on the results of thoracic endvascular aortic repair for acute,complicated,type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee[J].J Vasc Surg,2011,53(4):1082-1090.
[9] 舒畅,罗明尧,李全明,等.急诊腔内修复治疗合并严重并发症的急性B型主动脉夹层[C].中国心脏大会(CHC)2011暨北京国际心血管病论坛论文集.北京:国家心血管病中心,2011:299.
[10] KATO N,SHIMONO T,HIRANO T,et al.Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear:the complication-specific approach[J].Thorac Cardiovasc Surg,2002,124(2):306-312.
[11] 郭媛媛,杨斌,蔡红波,等.急诊腔内修复术治疗合并灌注不良综合征的急性StanfordB型主动脉夹层[J].中国普通外科杂志,2014,23(6):775-779.
[12] NIENABER C A.Influence and critique of the INSTEAD Trial(TEVAR versu medical treament for uncomplicated type B aortic dissection)[J].Semin Vasc Surg,2011,24(3):167-171.

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