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中华普通外科学文献(电子版) ›› 2015, Vol. 09 ›› Issue (01) : 5 -9. doi: 10.3877/cma.j.issn.1674-0793.2015.01.002

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主动脉夹层远端裂口的处理
陆清声1, 景在平1   
  1. 1. 200433 上海,第二军医大学附属长海医院血管外科,全军血管外科研究所
  • 收稿日期:2015-01-04 出版日期:2015-02-01

Management of aortic distal re-dissection

Qingsheng Lu1, Zaiping Jing1   

  • Received:2015-01-04 Published:2015-02-01
引用本文:

陆清声, 景在平. 主动脉夹层远端裂口的处理[J]. 中华普通外科学文献(电子版), 2015, 09(01): 5-9.

Qingsheng Lu, Zaiping Jing. Management of aortic distal re-dissection[J]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(01): 5-9.

图1 0.65 mm的CT扫描仔细观察才能发现的裂口
图2 相同平面主动脉CT显示,术前无裂口处(左图),术后出现裂口(右图)
图3 A:位于肾动脉与主动脉交界处的裂口, B:通过特殊设计的覆膜支架进行腔内隔绝, C: 3年后CTA随访显示
图4 一体化覆膜支架隔绝远端裂口左图: DSA造影,右图:术后1年CTA随访
图5 主动脉夹层术后CTA:开窗及分支支架隔绝所有裂口
图6 左图CTA显示远端分支区裂口,假腔明显增大;右图CTA示升主动脉至内脏分支动脉旁路术,腹主动脉裂口腔内隔绝术后
图7 封堵器放置于肠系膜上方的夹层裂口,主动脉腔内放置裸支架使封堵器更加固定,肠系膜上动脉内放置裸支架,避免封堵器盖住入
图8 DSA显示多层裸支架隔绝后,仍然持续内漏
图9 左图为远端夹层CTA;右图为术后CTA,腹主分支区应用多层裸支架,髂动脉区应用覆膜支架,腹主分支区存在内漏
图10 左图为术中DSA造影;右图为术后CTA随访,显示假腔完全血栓化
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