Comparative Study Of Acute And Chronic Type DebakeyⅢ Aortic Dissection With Stent Graft Endovascular Exclusion

Objective:By stent graft endovascular exclusion of acute and chronic DebakeyⅢ type AD diagnosis and treatment, compare this minimally invasive approach for the treatment of patients with different clinical results and follow-up period, analysis of the clinical features of aortic dissection DeabeyⅢ at different times.Methods: Our hospital in January 2007 - July 2014 to investigate 57 cases DebakeyⅢ dissection, patients before surgery through CTA (CT angiography), MRA (MRI), DSA (digital subtraction angiography), diagnosed Debakey Ⅲ dissection. In 25 cases of acute stage,32 cases of chronic stage. Depending on the patient image assessment, select the appropriate implant, department of radiology operating room monitoring, general anesthesia and tracheal intubation, cavity stent graft the operation of isolation treatment. After using the telephone, shuttle hospital follow-up CT scan, follow-up date for the 1,3,6,12 and for 24 months, a total 17 patients were lost, according to follow-up the process if there are complications: psychiatric symptoms, death, internal leakage, ascending aortic dissection, cerebral embolism, renal dysfunction, paralysis, etc., through on the effect of endovascular graft observation, o investigate the risk factors after operation the complication.Results:1. In this study,57 cases of patients with full-eluting stents. Where men accounted for 72.0% of acute, women accounted for 28.0%, ratio of about 3:1, fluctuated between 32-75 years of age; chronic male 81.25%, women accounted for 18.75 percent, about 4:1 ratio, age range 35-81 years.2. The first symptom of acute and chronic phase mainly for chest pain, chest and back pain, acute phase of chest pain and chest and back pain accounted for 84%. Chronic chest pain and chest and back pain accounted for 79%.3. Hypertension is a major initiative sandwich crowd,80% of the acute phase, chronic phase accounted for 90.63%.4. Acute phase DebakeyⅢ type and incidence of AD combination of pleural effusion was significantly higher than in chronic phase DebakeyⅢ type AD group.5. After discharge,1-24 month follow-up period, the follow-up of acute DebakeyⅢ type AD group was 64%, the follow-up in chronic phase DebakeyⅢ type AD group was 90.6%. Follow-up results showed that the acute phase of DebakeyⅢ type AD group had complications, compared different overall incidence of acute group higher overall complication in chronic phase group, in which leakage occurs in the acute phase of the group is higher than the chronic and chronic DebakeyⅢ type AD group phase group.Conclusion: EVGE short-term effect has been the treatment of aortic dissection DeBakeyⅢ get more and more recognized by clinicians, compared to traditional surgery, EVGE, with small trauma, safe, reliable, with the low mortality rate the rate and the characteristics, that is the safe and effective, the curative effect of prophase and metaphase have been fully affirmed, people who the satisfaction, but the latter effect may also need to be long-term or even lifelong follow-up to further. If circumstances allow the patients and their family members, DebakeyⅢ type A aortic dissection try to choose the chronic treatment of endovascular repair, the study found that acute treatment for operation in the security below the chronic period surgical operation, but also requires a comprehensive physical assessment before surgery, which is one of key factors the success of operation. Preoperative need to line all the relevant checks, for example cerebral angiography, if patients with on the right side of the vertebral artery smooth, intracranial Willis the complete ring, even if the break distance is less than 1.5 cm from the LSA, the same can line the stent graft, and occlusion of left subclavian arteries. In case of severe acute cerebral ischemia or left upper limb ischemia, can vascular bypass or rebuild. Postoperative was found, acute and chronic aortic dissection, most of the patients without endoleak, the incidence of leakage in the two periods are not high, a small portion of patients continued to have internal leakage occurs, if not more significant tumor-like expansion trend, without special treatment. In conclusion, endovascular aortic dissection success rate, complication rate, while main complications and when the main clinic acute and chronic level of a certain relationship.