目的

探讨主动脉腔内修复术（TEVAR）治疗合并有主动脉弓和（或）升主动脉倒撕裂的DeBakeyⅢ型主动脉夹层的手术时机及疗效。

方法

对2010年1月至2013年1月郑州大学第一附属医院介入科收治的10例DeBakey Ⅲ型主动脉夹层、同时合并有主动脉弓和（或）升主动脉逆向撕裂患者，在保守治疗的基础上行介入覆膜支架治疗，结合随访情况，探讨对该类患者行主动脉腔内修复术（TEVAR）的可行性、治疗时机及效果。

结果

1例患者血压控制差，入院后第3天行TEVAR治疗，术后第2天突发心包压塞而死亡；余9例患者在保守治疗4周，CT血管造影（CTA）显示逆向撕裂假腔内血栓稳定并部分吸收后，均安全实施了常规TEVAR，术后患者恢复较好，随访6～30个月，临床及影像检查证实效果良好。

结论

对合并有主动脉弓和（或）升主动脉逆向撕裂的DeBakey Ⅲ型主动脉夹层患者，仍可以行TEVAR手术且近期效果良好。治疗时机可选择在逆向撕裂假腔内血栓稳定后。

Objective

To explore the timing and the efficacy of thoracic endovascular aortic repair（TEVAR）treatment in DeBakey Ⅲ type aortic dissection associated with arch and ascending aorta anti-tearing.

Methods

Clinical data of 10 patients with DeBakey Ⅲ aortic dissection associated with arch and ascending aorta anti-tearing from January 2010 to January 2013 were retrospectively analyzed.All the patients had finally stepped stent therapy on the basis of conservative treatment，were erplored according to the follow-up results.

Results

One case conducted TEVAR treatment 3 days after admission because of poor blood pressure control，but died of sudden pericardial tamponade postoperative 2 days.After 4 weeks'conservative treatment all of 9 patients were performed TEVAR，the postoperative patients recovered well and were followed up for 6 to 30 months without adverse events.

Conclusions

False lumen thrombosis in ascending aorta and aortic arch are stable and partially absorbed after 4 weeks with conservative management in the patients who have DeBakey Ⅲaortic dissection with arch and ascending aorta anti-tearing，and then the aortic arch can provide a relatively stable anchoring zone in the proximal end for TEVAR.