复旦首创研究成果登Circulation

　　

生物通报道，来自复旦大学的消息，中山医院血管外科董智慧医师等在王玉琦教授和符伟国教授指导下完成的首创性Stanford B型主动脉夹层腔内修复术后并发逆行性A型夹层的系统论述。

 

文章Retrograde Type A Aortic Dissection After Endovascular Stent Graft Placement for Treatment of Type B Dissection于2009年2月10日发表在《循环》（Circulation）上。董智慧医师等的这项研究是我国血管外科界在《循环》上首次发表的由国内学者独立完成的临床研究类论著。

 

主动脉夹层也称主动脉夹层动脉瘤，是较常见也是最复杂、最危险的心血管疾病之一，其发病率为每年50-100人/10万人群，随着人们生活及饮食习惯的改变，其发病率呈上升趋势。国人发病率高于西方国家，以往主要依赖手术治疗，但是创伤巨大，死亡率和截瘫率高。

 

腔内修复是一种新的微创治疗方法，可明显降低死亡率和并发症率，已经成为Stanford B型夹层治疗的主要发展趋势。然而作为一种新方法，其中远期效果尤其是潜在的严重并发症一直是学术界关注的热点。中山医院血管外科作为“中国血管外科的摇篮”，是全国率先开展主动脉夹层腔内修复的少数单位之一，经过10年来的不断发展，目前已经完成743例，样本数居全球首位。经过对这些病例的中长期随访，发现“逆行性A型夹层”是主动脉夹层腔内修复术后尤其是围手术期首位的致死原因，而国际上对此尚缺乏系统研究。

 

针对于此，在王玉琦教授和符伟国教授的带领下，血管外科董智慧医师等在全院其它相关科室的积极协助下进行了系统研究，剖析了该并发症的发生原因和高危因素，总结出防治的有效方法，对于提高全球学术界对其的认识，进一步改善腔内治疗的安全性和有效性，促进该项新技术的长远发展都将发挥积极作用，同时有助于提升我国血管外科在全球学术界的影响力。

原文检索：文章Retrograde Type A Aortic Dissection After Endovascular Stent Graft Placement for Treatment of Type B Dissection

【Abstract】

Methods and Results— Eleven of 443 patients developed retrograde type A aortic dissection during or after stent grafting for type B dissection from August 2000 to June 2007. Of these 11 patients, 3 had Marfan syndrome. The Kaplan–Meier estimate of the rate of freedom from this event at 36 months is 97.4% (95% confidence interval, 0.95 to 0.99). The new entry was located at the tip of the proximal bare spring of the stent graft in 9 patients, was within the anchoring area of the proximal bare spring in 1, and remained unknown in 1 patient. Eight patients were converted to open surgery, and 2 received medical treatment. One patient suddenly died 2 hours after the primary stent grafting, and 2 died within 1 week after the surgical conversion, so mortality reached 27.3%. During the follow-up from 3 to 50 months, type I endoleak was identified in 1 patient 3 months after the surgical exploration and disappeared at 6 months.

 

Conclusions— Retrograde type A aortic dissection after stent grafting for type B dissection appears not to be rare and results from mixed causes. Fragility of the aortic wall and disease progression may predispose to it, whereas stent grafting–related factors make important and provocative contributions. Avoiding aortic arch stent grafting in Marfan patients, preferably selecting the endograft without the proximal bare spring for patients with a kinked aortic arch or with Marfan syndrome (if endografting is used), improving the device design, and standardizing endovascular manipulation might lessen its occurrence.

 

《循环》是国际最负盛名的心血管学术杂志，长期以来在全球心血管病学、血液病学以及外周血管病学杂志中均排名第一，最新影响因子12.755。