中國(guó)StanfordB型夾層EVAR治療現(xiàn)狀

1、中國(guó)StanfordB型夾層EVAR治療現(xiàn)狀符偉國(guó)Am J Cardiol. 2012 Oct 1;110(7):1056-61.中國(guó)主動(dòng)脈夾層文獻(xiàn)薈萃分析無準(zhǔn)確發(fā)病率統(tǒng)計(jì)數(shù)據(jù)B型夾層更多較IRAD數(shù)據(jù)更為年輕化: 51.110.9 y高血壓控制欠滿意類型中國(guó)IRADP 值Type A40.07%61.1%0.001Type B59.93%38.4% 2w) Tsilimparis et al. 2016; J Vasc Surg: submittedPresented by Tilo Kolbel et al in LINC2016, Jan 26-29, Leipzig持續(xù)逆向假腔灌注Ma

2、ni K. Eur J Vasc Endovasc Surg. 2012 pr;43(4):386-91.Presented by Matt Thompson in LINC2015, Jan 27-29, Leipzig, Germany.假腔血栓化誘導(dǎo) 切斷假腔持續(xù)灌注及術(shù)后主動(dòng)脈不良重塑PETTICOAT 技術(shù)遠(yuǎn)端破口的處理 封堵 開窗支架 / 分支支架 假腔栓塞技術(shù)遠(yuǎn)端裸支架PETTICOAT技術(shù)（Proximal descending aortic stentgraft plus distal bare metal stent )Nienaber et al. J Endovasc

3、Ther.2006 Dec;13(6):738-46.Canaud L. Ann Cardiothorac Surg. 2014 May;3(3):223-33. 系統(tǒng)綜述n=108技術(shù)成功率: 95.3%30天死亡率: 2.7%促進(jìn)主動(dòng)脈重塑: 高比例假腔回縮及真腔擴(kuò)張胸主動(dòng)脈段假腔完全血栓化率70.4%，腹主動(dòng)脈段假腔完全血栓化率13.5%Performed in Zhongshan Hospital since 2009 遠(yuǎn)端破口封堵假腔栓塞技術(shù)PlugsGlueCoils支架源性新發(fā)破口發(fā)生率: 1.3-27% (中山醫(yī)院3.4%)死亡率高達(dá)28.6%支架與遠(yuǎn)端真腔尺寸差異支架自身的回

4、直力錐度支架更加順應(yīng)的支架設(shè)計(jì)遠(yuǎn)端限制性支架Dong Z, Fu W. J Vasc Surg. 2010 Dec;52(6):1450-7. Ankura II (Lifetech, Inc)錐度可選 4mm, 6mm, 8mmComfortable TAG (GORE)更加順應(yīng)的設(shè)計(jì)遠(yuǎn)端真腔限制性裸支架（RBS）Feng J. J Vasc Surg. 2013 Feb;57(2 Suppl):44S-52S.與常規(guī)TEVAR相比, TEVAR+ RBS 具有更低的支架源性新發(fā)破口發(fā)生率 (0% vs 2.9%;P= .033)及更少的二次干預(yù)比例(3.9% vs 9.3%;P= .040)。概述B型主動(dòng)脈夾層在中國(guó)發(fā)病率較高，但目前尚無準(zhǔn)確的流行病學(xué)統(tǒng)計(jì)數(shù)據(jù)目前單一直行TEVAR移植物是主要治療方案弓部分支型支架技術(shù)在未來可能