| Background And ObjectiveHypertension is a chronic disease and most prevalent in recently days, besides it is also a variety of the most critical risk factors for cardiovascular disease, such as MI,HF,CKD. But undoubtedly, the most dangerous and most terrible one is aortic dissection(AD). AD is often caused by the blood crush through the aortic hypoplasia or cause of the invasion and neointimal formation rip into the aortic wall caused by the normal artery wall of separation and the formation of two chambers of the true and false. In recently days,it is a commen disease. Of course, the risk factors of aortic dissection is not simply for hypertension, aortic dissection intimal dysplasia transformation, trauma, and so on. Hypertension in the general population because of the lack of awareness of hypertension, allowing the disease to become a high incidence of the disease.AD as an extremely dangerous cardiovascular disease, the AI is about (5-10)/1000000, male patients:female patients is about3:1, worldwide type III AD’MR has reached27.4%in the incidence of acute period mortality, mortality of untreated patients within24hours up to21%as high as50%within two days of onset reported case fatality rate was14.9%. In our country, and therefore timely and accurate diagnosis and treatment is the key to improve the success rate of the disease, and can effectively reduce the MR of patients. In recent years, EVR in the treatment of the rapid development in type Ⅲ aortic dissection, DeBakey Ⅲ aortic dissection preference. EVR is the most commonly used method for the use of the stent. Intra-aortic stent implantation for the principle is the use of the expansion of the role of stents, stents and aortic intima in close conformity, effectively covering the arterial intima rupture, tamponade dissection break and resumed aortic blood flow, and the occlusive arterial dissection false lumen thrombosis of the machine to achieve the effective reconstruction of the arterial lumen, thus preventing aneurysm increases with rupture. Such a procedure has:①Operation time is short,less trauma, and simplify the surgical procedure easy to tolerate. Patients with other system diseases who can’t to thoracotomy laparotomy can be accept this operation;②Fewer complications;③Hospitalization time is short, quick recovery;④Less bleeding, general surgery without blood transfusion;⑤Treatment effect is indeed, the case fatality rate is low. This article aims to retrospective analysis of the short-term effect of our department43cases of type Ⅲ aortic dissection patients and do the follow-up.MethodsFrom January2012to2012in June, we selected47cases of cardiac surgery department of Shandong University Qilu Hospital DeBakey III aortic dissection patients, through the femoral artery, we placed in the descending aorta endovascular stent line dropendovascular repair of aortic lacerations isolated. All above were operated in the Qilu Hospital hybridization operating room and under general anesthesia, including two cases of the descending aorta break closer distance of the left subclavian artery, less than1.5cm, covering the the closed left subclavian artery stent, we not line the left subclavian bypass graft surgery, postoperative ischemic symptoms;42cases the descending aorta endovascular repair of lacerations stent placement, retention of the left subclavian artery patency. All surgical first anatomical femoral artery and pre-sewn purse+5-0Prolene slip line, puncturing the femoral artery under direct vision, pig tail catheter aortic angiography, further defined the descending aorta break position, and then measuring the stent anchoring area diameter to determine stent size after stent implantation, angiography to determine the effects of stent placement, the purse-string suture knot clear sutured incision bleeding and hematoma after implantation again. Record select cases of general information (including name, address, telephone number, etc.), a history of cardiovascular disease, the occurrence of the first symptom and postoperative complications, admission diagnosis, treatment and postoperative outcomes. The six-month review of the chest CT, to clear the stent status of each patient were followed up after discharge.ResultsThe IS of this disease is severe pain in chest and back, but no specificsignificance, some patients can oliguria, abdominal pain, bloating, as the first symptom; this group underwent endovascular aortic stent implantation were functioning successfully, because preoperative and intraoperative blood pressure control stents, surgery does not appear misplaced, shift, rupture, and the occurrence of surgical intervention. Three cases in which small endoleak surgery appears immediately after the neutral BD disappear; two cases of lacerations from the LSA open close the bracket closed left subclavian artery;42patients recovered well, does not appear to lung infection atelectasis, arterial embolization, paraplegia and other complications. The mean operative time was1.8hours, mean blood loss was130ml the average recovery activities time of two days, the average length of stay of7days. After one month and six months later CT shows the stent morphology intact, without twisting and shifting of blood flow, abdominal organs by the true lumen of the blood supply. Clinical follow-up of1-6months,47patients,2patients died, the short-term survival was95.7%.ConclusionType III aortic dissection is extremely dangerous clinical aortic disease, the first symptom of more severe chest and back pain, but no specific significance, few patients can oliguria, abdominal pain, bloating, as the first symptom.Aortic endovascular stent implantation can effectively curb the development of type Ⅲ aortic dissection. And it can prevent its retrograde or antegrade torn aorta, improve survival and quality of life after effect. Ⅲ aortic dissection This surgical procedure can significantly improve the cure rate and LSR. |
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