Preliminary Clinical Study For The Distal Crevasse Of Stanford Type B Aortic Dissection

Objective: To study the distribution characteristics of distal crevasses on Stanford type B aortic dissection,explore the distal crevasses classification method; To comparison the curative effect of two differenttreatment principles and exploratory put forward the Stanford type B aortic dissection distal crevassestreatment principles.Methods: Using electronic medical record management system in xinjiang autonomous region people’shospital, retrieve all hospital between January2010and June2010diagnosis includes cases of aorticdissection, rotating its effect to the CTA and other related information, on the distribution of distalcrevasses records.According to the different treatment principles of distal crevasses in aortic dissection todivide the patients into two groups.(1.Follow the treatment principle group: take the princ iple of from nearto far,endovascular repair of distal crevasses, if not deal with the crevasses involving visceral arteries, donot handle the distal crevasses;2.Dot not follow the treatment principle group: do not deal with thecrevasses involving visceral arteries,endovascular repair of it’s distal crevasses).Analyze the postoperativediscomfort (chest and back pain, lower back pain) incidence, postoperative distal crevasses happeningagain and false lumen changes respectively.Results: Refer to115cases with Stanford type B aortic dissection CTA data, including101cases withdistal crevasses (87.83%), and89patients (88.12%) have more than two distal crevasses, the101cases ofStanford type B aortic dissection has a total of240distal crevasses, an average of2.37per case,24(10%)located between the first break and celiac artery, located in a zone between the celiac artery and renal arteryhave135(56.25%),57(23.75) located between the renal artery and distal breach of aortic.and located inthe zone of iliac artery have24(10%).The screening of a total of115patients were included53cases ofpatients were consistent with the rules,53patients were included in the standard,in which follow thetreatment principle group has37cases,and do not follow the treatment principle group have16patients.Two groups don’t have significance statistically(P>0.05)in complained of postoperativediscomfort and postoperative distal crevasses happening again.Two groups of postoperative changes in thefalse lumen was statistically significant (P <0.05).Conclusions: Most Stanford type B aortic dissection patients with distal crevasses exist, and the distalcrevasse more offen appear in the area involving visceral artery, combined with its different in distributioncharacteristics and processing methods,we put forward the classification method, namely: Ⅰ type: thedistal crevasse is located in the zone of the thoracic artery; Ⅱ type: the distal crevasse is close to thevisceral artery or involvement it; Ⅲ type:the distal crevasse is lower than the renal artery,not involvingthe visceral artery; Ⅳ type: the distal crevasse is located in the zone of the iliac artery. Compared twogroups of related indicators we found that the prognosis of patients with principles of treatment group is more better,in clinical work, first of all should be according to the size of the distal crevasse and reverseflow, the speed of the false lumen enlargement and presence of clinical symptoms of ruptured to decidewhether to treat the distal crevasse, if need to deal, in the repair processing should according to thesequence from near to far, if you don’t deal with the visceral artery crevasse, also should not handle itsdistal crevasse.