Современное состояние проблемы эндоваскулярного лечения при расслоении аорты B-типа

   Эндопротезирование грудного отдела аорты является малоинвазивным высокотехнологичным методом лечения острого и хронического расслоения аорты B-типа по классификации Stanford, главная цель которого заключается в предупреждении разрыва аорты и разрешении синдрома мальперфузии внутренних органов. Несмотря на меньшую инвазивность, эндопротезирование аорты, как и другие хирургические процедуры, имеет ряд осложнений. Неуклонный рост частоты выполняемых эндоваскулярных протезирований и использование многокомпонентных систем (два и более стент-графта) закономерно привели к появлению большего числа послеоперационных осложнений, ассоциированных именно с конструкцией и имплантацией стент-графтов. К ним можно отнести ретроградное расслоение, развитие дистальной стент-индуцированной новой фенестрации, миграцию и расхождение модулей стент-графтов, нарушение целостности стент-графтов и разрыв аорты, особенно у пациентов с генетически детерминированным поражением соединительной ткани. Проведенный обзор литературы позволил выявить основные механизмы, лежащие в основе патогенеза каждого из перечисленных осложнений. Тщательное планирование, проведение морфометрического анализа аорты, а также соблюдение рекомендаций позволят сократить количество осложнений после эндопротезирования грудного отдела аорты у пациентов с расслоением аорты. Важно отметить, что регулярное наблюдение с оценкой динамики происходящих изменений по данным мультиспиральной компьютерно-томографической аортографии после эндопротезирования аорты cлужит ключевым фактором своевременного выявления осложнений и их успешного лечения.

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