Intracavitary isolation in the treatment of Stanford type A aortic dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENG Qingjian ¹ , HE Yuyuan ¹ , CHE Zhe ¹ , GAO Pengcheng ¹ , WU Jidong ²

1. First Department of General Surgery, Zhangye People’s Hospital Affiliated to Hexi Univerrsity, Zhangye, Gansu 734000, P. R. China;
2. Department of Vascular Surgery, Beijing Aerospace General Hospital, Beijing 100000, P. R. China;

Corresponding?author：

CHENG Qingjian, Email: qfqsjq@163.com

Keywords：

aortic dissection; intracavitary isolation; stent graft

DOI：

10.7507/1672-2531.201912060

Video：

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ObjectiveTo explore the effect of using a stent graft to treat a Stanford type A aortic dissection with the ascending aorta in the cavity.MethodA retrospective review was made of the clinical data of a patient with Stanford type A aortic dissection admitted to Zhangye People’s Hospital Affiliated to Hexi University in December 2016.ResultsAfter the patient underwent general anesthesia aortic dissection and stent graft treatment, the dissection fracture completely disappeared. After 2 years of follow-up, the patient’s pseudocavity hematoma was completely absorbed. The operative time was 30 min and the blood loss was about 5 mL. There were no complications such as avulsion of dissection, internal leakage, cerebral infarction, myocardial infarction, nervous system, and other complications occurred.ConclusionFor Stanford type A aortic dissection with a tear located in the ascending aorta, intracavitary treatment with coated stent is feasible for ascending aortic dissection with good vascular conditions and tear location through accurate preoperative assessment.

Citation： CHENG Qingjian, HE Yuyuan, CHE Zhe, GAO Pengcheng, WU Jidong. Intracavitary isolation in the treatment of Stanford type A aortic dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 729-733. doi: 10.7507/1672-2531.201912060 Copy

1.	王利新, 符偉國. 主動脈夾層治療的現況. 中國血管外科雜志: 電子版, 2016, 8(1): 1-5.
2.	中華醫學會外科學分會血管外科學組. 主動脈夾層腔內治療指南. 中國實用外科雜志, 2008, 28(11): 909-912.
3.	中國醫師協會心血管外科分會大血管外科專業委員會. 主動脈夾層診斷與治療規范中國專家共識. 中華胸心血管外科雜志, 2017, 33(11): 641-654.
4.	Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5.	劉一人, 徐兆明, 齊一俠, 等. 腔內技術治療 Kommerell 憩室的臨床研究. 中國普外基礎與臨床雜志, 2019, 26(9): 1101-1105.
6.	董智慧, 符偉國, 王玉琦, 等. 胸主動脈腔內修復術后支架源性新破口—從支架力學損傷角度的思考. 中國普外基礎與臨床雜志, 2011, 18(10): 1031-1038.
7.	袁丁, 趙紀春, 康裕建, 等. 3D 打印技術輔助復雜主動脈夾層腔內治療. 中國普外基礎與臨床雜志, 2015, 22(7): 852-854.
8.	劉昭, 李旭冉, 張明, 等. 3D 打印結合支架束徑技術預三開窗治療 Stanford A 型主動脈夾層1例. 中國血管外科雜志: 電子版, 2019, 11(2): 142-144.
9.	楊探, 廖斌, 蘭永樹, 等. 三分支覆膜支架行主動脈弓重建治療 Stanford A 型主動脈夾層效果的臨床隨訪. 中國胸心血管外科臨床雜志, 2019, 26(9): 933-935.
10.	Hsu CP, Huang CY, Wu FY. Relationship between the extent of aortic replacement and stent graft for acute DeBakey type Ⅰ aortic dissection and outcomes: results from a medical center in Taiwan. PLoS One, 2019, 14(1): e0210022.
11.	Faure EM, El Batti S, Sutter W, et al. Stent-assisted balloon-induced intimal disruption and relamination of distal remaining aortic dissection after acute DeBakey type Ⅰ repair. J Thorac Cardiovasc Surg, 2019, 157(6): 2159-2165.
12.	Merkle J, Sabashnikov A, Liebig L, et al. Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection. Perfusion, 2019, 34(5): 375-383.
13.	Kim TH, Song SW, Heo W, et al. Complete thoracic aorta remodeling after endovascular aortic repair: a new therapeutic goal for chronic DeBakey Ⅲb aneurysms. Semin Thorac Cardiovasc Surg, 2019, 31(3): 444-450.
14.	中國心胸血管麻醉學會心血管麻醉分會. Stanford A 型主動脈夾層外科手術麻醉中國專家臨床路徑管理共識 (2017). 麻醉安全與質控, 2018, 2(1): 1-6.
15.	Merkle J, Sabashnikov A, Deppe AC, et al. Impact of different aortic entry tear sites on early outcomes and long-term survival in patients with Stanford A acute aortic dissection. Thorac Cardiovasc Surg, 2019, 67(5): 363-371.
16.	Reed AB, Self P, Rosenberg M, et al. Pre-emptive thoracic endovascular aortic repair is unnecessary in extended type A (DeBakey type Ⅰ) aortic dissections. J Vasc Surg, 2019, 70(3): e68-e69.
17.	常光其. Stanford A 型主動脈夾層腔內治療后并發癥的原因和預防. 中國血管外科雜志: 電子版, 2012, 4(4): 209-211.
18.	劉正琴. A 型主動脈夾層術后常見神經系統并發癥的系列研究. 山東: 山東大學, 2017.
19.	宋先榮, 程兆云, 劉富榮, 等. Stanford A 型主動脈夾層術后譫妄的臨床研究. 中華胸心血管外科雜志, 2016, 32(10): 607-611.
20.	Kim TH, Song SW, Lee KH, et al. Outcomes of stentless thoracic endovascular aortic repair for chronic DeBakey Ⅲb aneurysms. Ann Thorac Surg, 2018, 106(5): 1308-1315.
21.	尚玉強, 戴仕林, 吳偉, 等. 一站式雜交手術治療急性 Stanford A 型主動脈夾層. 臨床心血管病雜志, 2016, 32(8): 823-825.
22.	國家心血管病專業質控中心專家委員會血管外科專家工作組. 胸主動脈腔內修復手術質量評價指標體系的中國專家共識. 中國循環雜志, 2018, 33(7): 627-630.
23.	Tang GH, Malekan R, Yu CJ, et al. Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S186-S190.
24.	左健, 楊劍, 王少瑋, 等. 封堵器治療局限性升主動脈穿通性潰瘍. 心肺血管病雜志, 2013, 32(6): 730-731.
25.	王石雄, 高秉仁, 王煒, 等. 食管超聲引導下經胸封堵治療局限性主動脈夾層. 臨床心血管病雜志, 2016, 32(6): 636-638.
26.	張喆, 陳學明, 李晨宇, 等. 腔內治療破口位于升主動脈的 Stanford A 型主動脈夾層. 中國普通外科雜志, 2015, 24(12): 1649-1653.
27.	黃晨, 周敏, 劉長建, 等. Stanford A 型主動脈夾層的腔內支架治療進展. 中國血管外科雜志: 電子版, 2016, 8(2): 155-159.
28.	葉志東. 破口位于升主動脈以遠的 Stanford A 型夾層動脈瘤腔內治療策略//中國醫師協會、中國醫師協會中西醫結合醫師分會. 2014中國醫師協會中西醫結合醫師大會論文摘要集. 2014: 136.
29.	Ye C, Chang G, Li S, et al. Endovascular stent-graft treatment for Stanford type A aortic dissection. Eur J Vasc Endovasc Surg, 2011, 42(6): 787-794.
30.	Vallejo N, Rodriguez-Lopez JA, Heidari P, et al. Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. J Vasc Surg, 2012, 55(2): 318-325.

1. 王利新, 符偉國. 主動脈夾層治療的現況. 中國血管外科雜志: 電子版, 2016, 8(1): 1-5.
2. 中華醫學會外科學分會血管外科學組. 主動脈夾層腔內治療指南. 中國實用外科雜志, 2008, 28(11): 909-912.
3. 中國醫師協會心血管外科分會大血管外科專業委員會. 主動脈夾層診斷與治療規范中國專家共識. 中華胸心血管外科雜志, 2017, 33(11): 641-654.
4. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(41): 2873-2926.
5. 劉一人, 徐兆明, 齊一俠, 等. 腔內技術治療 Kommerell 憩室的臨床研究. 中國普外基礎與臨床雜志, 2019, 26(9): 1101-1105.
6. 董智慧, 符偉國, 王玉琦, 等. 胸主動脈腔內修復術后支架源性新破口—從支架力學損傷角度的思考. 中國普外基礎與臨床雜志, 2011, 18(10): 1031-1038.
7. 袁丁, 趙紀春, 康裕建, 等. 3D 打印技術輔助復雜主動脈夾層腔內治療. 中國普外基礎與臨床雜志, 2015, 22(7): 852-854.
8. 劉昭, 李旭冉, 張明, 等. 3D 打印結合支架束徑技術預三開窗治療 Stanford A 型主動脈夾層1例. 中國血管外科雜志: 電子版, 2019, 11(2): 142-144.
9. 楊探, 廖斌, 蘭永樹, 等. 三分支覆膜支架行主動脈弓重建治療 Stanford A 型主動脈夾層效果的臨床隨訪. 中國胸心血管外科臨床雜志, 2019, 26(9): 933-935.
10. Hsu CP, Huang CY, Wu FY. Relationship between the extent of aortic replacement and stent graft for acute DeBakey type Ⅰ aortic dissection and outcomes: results from a medical center in Taiwan. PLoS One, 2019, 14(1): e0210022.
11. Faure EM, El Batti S, Sutter W, et al. Stent-assisted balloon-induced intimal disruption and relamination of distal remaining aortic dissection after acute DeBakey type Ⅰ repair. J Thorac Cardiovasc Surg, 2019, 157(6): 2159-2165.
12. Merkle J, Sabashnikov A, Liebig L, et al. Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection. Perfusion, 2019, 34(5): 375-383.
13. Kim TH, Song SW, Heo W, et al. Complete thoracic aorta remodeling after endovascular aortic repair: a new therapeutic goal for chronic DeBakey Ⅲb aneurysms. Semin Thorac Cardiovasc Surg, 2019, 31(3): 444-450.
14. 中國心胸血管麻醉學會心血管麻醉分會. Stanford A 型主動脈夾層外科手術麻醉中國專家臨床路徑管理共識 (2017). 麻醉安全與質控, 2018, 2(1): 1-6.
15. Merkle J, Sabashnikov A, Deppe AC, et al. Impact of different aortic entry tear sites on early outcomes and long-term survival in patients with Stanford A acute aortic dissection. Thorac Cardiovasc Surg, 2019, 67(5): 363-371.
16. Reed AB, Self P, Rosenberg M, et al. Pre-emptive thoracic endovascular aortic repair is unnecessary in extended type A (DeBakey type Ⅰ) aortic dissections. J Vasc Surg, 2019, 70(3): e68-e69.
17. 常光其. Stanford A 型主動脈夾層腔內治療后并發癥的原因和預防. 中國血管外科雜志: 電子版, 2012, 4(4): 209-211.
18. 劉正琴. A 型主動脈夾層術后常見神經系統并發癥的系列研究. 山東: 山東大學, 2017.
19. 宋先榮, 程兆云, 劉富榮, 等. Stanford A 型主動脈夾層術后譫妄的臨床研究. 中華胸心血管外科雜志, 2016, 32(10): 607-611.
20. Kim TH, Song SW, Lee KH, et al. Outcomes of stentless thoracic endovascular aortic repair for chronic DeBakey Ⅲb aneurysms. Ann Thorac Surg, 2018, 106(5): 1308-1315.
21. 尚玉強, 戴仕林, 吳偉, 等. 一站式雜交手術治療急性 Stanford A 型主動脈夾層. 臨床心血管病雜志, 2016, 32(8): 823-825.
22. 國家心血管病專業質控中心專家委員會血管外科專家工作組. 胸主動脈腔內修復手術質量評價指標體系的中國專家共識. 中國循環雜志, 2018, 33(7): 627-630.
23. Tang GH, Malekan R, Yu CJ, et al. Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S186-S190.
24. 左健, 楊劍, 王少瑋, 等. 封堵器治療局限性升主動脈穿通性潰瘍. 心肺血管病雜志, 2013, 32(6): 730-731.
25. 王石雄, 高秉仁, 王煒, 等. 食管超聲引導下經胸封堵治療局限性主動脈夾層. 臨床心血管病雜志, 2016, 32(6): 636-638.
26. 張喆, 陳學明, 李晨宇, 等. 腔內治療破口位于升主動脈的 Stanford A 型主動脈夾層. 中國普通外科雜志, 2015, 24(12): 1649-1653.
27. 黃晨, 周敏, 劉長建, 等. Stanford A 型主動脈夾層的腔內支架治療進展. 中國血管外科雜志: 電子版, 2016, 8(2): 155-159.
28. 葉志東. 破口位于升主動脈以遠的 Stanford A 型夾層動脈瘤腔內治療策略//中國醫師協會、中國醫師協會中西醫結合醫師分會. 2014中國醫師協會中西醫結合醫師大會論文摘要集. 2014: 136.
29. Ye C, Chang G, Li S, et al. Endovascular stent-graft treatment for Stanford type A aortic dissection. Eur J Vasc Endovasc Surg, 2011, 42(6): 787-794.
30. Vallejo N, Rodriguez-Lopez JA, Heidari P, et al. Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. J Vasc Surg, 2012, 55(2): 318-325.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Intracavitary isolation in the treatment of Stanford type A aortic dissection

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