主动脉弓部病变腔内修复术的研究  

Endovascular aneurysm repair of the aortic arch lesions

作　　者：郭伟[1] 刘小平[1] 尹太[1] 贾鑫[1] 梁法启[1] 张国华[1] 

机构地区：[1]中国人民解放军总医院血管外科,北京100853

出　　处：《中国实用外科杂志》2007年第2期136-138,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨进行腔内修复术(EVAR)时头、臂动脉的处理方案。方法1998年9月至2006年2月,共63例EVAR涉及到头、臂动脉的处理。左锁骨下动脉的处理:一期部分或全部覆盖;不行重建;先外科重建,然后腔内覆盖;完全腔内重建。左颈总动脉的处理:先外科重建,然后腔内覆盖;腔内覆盖大部分,然后腔内重建。无名动脉的处理:先外科重建左颈总动脉和左锁骨下动脉,然后应用分叉支架型血管完全重建主动脉弓。结果54例仅须处理左锁骨下动脉,8例须处理左颈总动脉和左锁骨下动脉,1例须处理弓上3分支血管。所有辅助技术均取得成功。左锁骨下动脉未进行重建者术后左肱动脉平均收缩压(62.6±24.2)mmHg(1mmHg=0.133kPa)。EVAR后30d内漏发生率17.5%。结论对有选择的病人,一期覆盖左锁骨下动脉是安全的。通过辅助技术,可以扩大EVAR的手术适应证。长期结果须行进一步随访。Objective To discuss the methods of Endovascular aneurysm repair （EVAR） for attic arch aneurysm or dissection. Methods From Sep. 1998 to Feb. 2006,63 cases related with the super-arch branches. Three methods Were used in the lesions with left subelavain artery （LSA） invasion only, covering the LSA without reconstruction, LSA bypass before EVAR or covering LSA completely and then re-open it by endovascular technique. To the lesions with LSA and left common carotid artery （LCCA） invasion, a traditional bypass of LCCA and LSA was done before EVAR, or covering most of LCCA first, and then reconstructed it through LCCA by endovascular technique. To the lesions with three super-arch branches invasion, a bifurcated stent-graft was planted for reconstructing the artic arch. Results LSA was treated in 54 eases, LSA and LCCA were treated in 8 cases and all of the super-arch branch arteries were treated in 1 case. All of the auxiliary techniques were enforced successfully. The primary average systolic pressure of left brachial artery was （62. 6 ± 24. 2 ） mmHg in cases without LSA reconstruction. The 30-days endoleak rate was 17.5%. Conclusion Covering the LSA is safe to the patients with normal contraliteral vertebral and basilar artery. EVAR combined with supplementary techniques can expand the EVAR indications of aortic arch lesions. The long term result still keep in follow up.

关 键 词：动脉瘤 动脉夹层 主动脉弓 支架型血管 

分 类 号：R6[医药卫生—外科学]