目的评估腔内手术治疗中主动脉综合征（MAS）的安全性及有效性。
方法本研究为回顾性纵向研究。收集2008年1月至2023年5月于复旦大学附属中山医院血管外科接受腔内治疗的20例成年MAS患者的临床资料，其中男性8例，女性12例；年龄（37.3±14.8）岁。术后3、6、12个月及之后每年进行随访。观察和记录围手术期和随访期情况，记录踝肱指数（ABI）和CT血管造影（CTA）检查结果。采用配对 t检验比较手术前后病变段近远心端收缩压压差和ABI的差异，采用Kaplan-Meier法绘制无再干预生存曲线。
结果20例成年MAS患者，包括13例降主动脉狭窄，7例肾下腹主动脉狭窄。20例均合并高血压，其中16例为难治性高血压。术前16例行ABI检查，ABI值为0.77±0.15。20例患者均接受腔内治疗，包括支架植入及球囊扩张，其中17例手术成功，技术成功率为85.0%。围手术期内1例患者发生脑梗死，无患者死亡。术后病变段近远心端动脉收缩压压差［（14.7±11.3）mmHg 比（62.4±12.6）mmHg， t=12.60， P＜0.001］较术前下降，16例患者术后ABI（0.92±0.24 比 0.77±0.15， t=2.12， P=0.004）较术前改善，差异均有统计学意义。20例患者均获得随访数据，随访时间为（71.9±53.8）个月（范围：12～148个月）。随访期间，2例患者死亡，1例出现支架远端主动脉新发破口，1例发生脑梗死。无患者因MAS或手术相关因素再干预，5年无再干预生存率为94.7%。16例患者术后1年ABI为0.92±0.21（ t=2.33， P=0.027），其中13例患者术后3年ABI仍较术前改善（0.74±0.18 比 0.90±0.16， t=2.40， P=0.025），差异均有统计学意义。术前16例难治性高血压患者中，术后4例高血压治愈，11例高血压改善，1例高血压未变。
结论腔内手术在治疗MAS方面具有较为理想的长期疗效，且在改善症状、缓解高血压方面疗效较理想。
ObjectiveTo evaluate the safety and efficacy of endovascular surgery for middle aortic syndrome (MAS).
MethodsAs a retrospective longitudinal study, the clinical data of 20 adult MAS cases who underwent endovascular treatment at the Department of Vascular Surgery, Zhongshan Hospital, Fudan University, from January 2008 to May 2023 were collected, including 8 males and 12 females, with a mean age of (37.3±14.8) years. The follow-up was conducted 3, 6, 12 months after surgery and annually thereafter, during which the ankle-brachial index (ABI) and CTA examination results were recorded. The paired t-test was adopted for the comparison of ABI and systolic pressure difference between the proximal and distal arteries of the lesion before and after surgery, and the Kaplan-Meier method was utilized for the estimation of intervention-free survival.
ResultsThe 20 adult patients with MAS included 13 with descending aortic stenosis and 7 with infrarenal abdominal aortic stenosis. All patients were with hypertension, including 16 with resistant hypertension. 16 patients underwent ABI testing preoperatively, with an ABI of 0.77 ± 0.15. All patients underwent endovascular treatment, including stent placement and balloon dilatation. Among them, 17 surgeries were successful, with a technical success rate of 85.0% In the perioperative period, one patient experienced cerebral infarction and no mortality occurred. The postoperative systolic pressure difference between the proximal and distal arteries of the lesion declined in contrast to that of the preoperative period [(14.7±11.3) mmHg vs (62.4±12.6) mmHg, t=12.60, P<0.001], and the ABI of the 16 patients were improved after the surgery (0.92±0.24 vs 0.77±0.15, t=2.12, P=0.004), both were with statistically significant differences. Follow-up data for all 20 patients was obtained. During the average follow-up duration of (71.9±53.8) months (12-148 months), two patients died. One patient was with re-dissection of the aorta at the distal end of the stent, and one experienced cerebral infarction. No patient received reintervention due to MAS or surgery-related factors, and the 5-year intervention-free survival rate was 94.7%. The ABI of the 16 patients was 0.92±0.21 ( t=2.33, P=0.027) one year after the surgery. Among them, 13 patients maintained improvement in ABI three years after the surgery compared to that before the surgery (0.74±0.18 vs 0.90±0.16, t=2.40, P=0.025) with statistically significant differences. Among 16 patients with refractory hypertension preoperatively, 4 achieved complete relief, 11 had improvement, and 1 had no change after the surgery.
ConclusionEndovascular intervention has ideal long-term efficacy in treating MAS and alleviating hypertension.
刘浩,陈斌,蒋俊豪,等. 腔内治疗中主动脉综合征的长期随访结果[J]. 中华血管外科杂志（中英文）,2025,10(01)：23-28.
DOI:10.3760/cma.j.cn101411-20240621-00059版权归中华医学会所有。
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除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
刘浩：研究设计、文章撰写、数据收集、患者随访；陈斌、蒋俊豪：研究设计、文章撰写；石赟、马韬、林长泼：数据分析；方刚：数据收集、患者随访；张晓乐：患者随访；董智慧、符伟国：研究设计、文章修改
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