| Objective To introduce the techniques and effects of endovascular graft exclusion in the treatment of aortic dissection, analyses the report of prophase and metaphase follow up report.Methods Endovascular graft exclusion was performed in 121 patients with aortic dissection (the range of age was from 28 to 83 years, 98 male and 23 female) . Computed tomography angiography (CTA) , transthoracic echocardiography (TTE), magnetic resonance angiography (MRA) was performed as a preoperative evaluation methods. The position and extent of the aortic dissection were analyzed through angiography, during this course a pig-tail catheter was percutaneous left brachial artery into ascending aorta to allow intraprocedural angiography and measure the distance between primary tear to the orifice of left subclavian artery and dia. of true and false lumen. The stent-graft were inserted from the femoral artery to exclued the intimal tear of thoracic aorta, and all operations were performed under DSA guidance.Results Main symptom was"tear"chest or back pain in 88 patients (72.73%), significant comorbidities was hypertension in 114 patients (94.21%). 101 case's (83.47%) abdominal aorta involed by the false lumen. 79 case's (65.29%) renal arteries involed by the false lumen. Endovascular graft exclusion was successfully performed in all 121 patients (Stanford B type 116 cases, Stanford A type 5 cases). 124 Stent Grafts were installed successfully in our group, there were 3 patients received 2 Stent Grafts, 7 patients received Cuff, 2 patients underwent left carotid-subclavian artery by-pass. 3 patients received Patent Ductus Arteriosus Occlusion to seal origin of LSA, 21 patients haven't received left carotid-subclavian artery by-pass, directly seal orifice of LSA. 18 cases (14.88%) have endo-leakage in intraoperative, after treatment endo-leakage disappear. After operation, angiography of aorta showed the aortic dissection intimal tear was excluded absolutely, no changes in the position or configuration of the graft were observed. A shrinkage of the false lumen was observed. no patient had to appeal to thoracic surgery. We use Logistic regession analyses found that acute stage operation and combined multiple organ dysfunction syndrome were independent risk factor of preoperative death. The range of postoperative follow-up was form 1 to 48 months. 8 patients was death in 3 month after operation. 4 patients was die in MODS, 2 patients was die in aortic dissection rupture, 1 patients was die in hepatic cancer, 1 patients was die in unknown reason. 114 of the patients accepted a reexamination of CTA in third month after operation, all the false lumen that near the LSA was disappear, the dia. of thoracic aorta gradually wide, position and feature of stent graft was same. 1 case occurrence type A aortic dissection, when place a stent graft, the false lumen was disappear. All cases accepted a reexamination of CTA, same of cases have stabilize distal false lumen.Conclusion The main etiological factor of aortic dissection was hypertension. High incidence of type B aortic dissection involve abdominal aorta. Multirow helix CT can reconstruction aorta which can give a clear view for diagnosis. Acute stage operation was independent risk factor of preoperative death. The patient whose neck of aortic dissection was short can directly seal orifice of LSA. Endo-leakage was main complication of EVGE, most part of endo-leakage can get right treatment during intraoperative. Some of patients will have a stabilize distal false lumen. Endovascular graft exclusion is a secure and effective way to treat aortic dissection, the rate of death and complications caused by this operation is low, and a famous rate of success and survival could be acquired after the operation and follow-up of short-term and mid-term. |
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