胸主动脉腔内修复术中选择性覆盖左锁骨下动脉疗效分析  

Analysis of selective coverage of the left subclavian artery during thoracic endovascular aortic repair

作　　者：薛玉国[1] 黄连军[1] 黄小勇[1] 李宇[1] 郭曦[1] 李铁铮[1] 韩晓峰[1] 

机构地区：[1]北京市心肺血管疾病研究所首都医科大学附属北京安贞医院介入诊疗科,100029

出　　处：《中国医药》2013年第6期750-752,共3页China Medicine

基　　金：首都医学发展科研基金（2009-3115）

摘　　要：目的探讨胸主动脉腔内修复术（TEVAR）在支架近端锚定区不足时选择性覆盖左锁骨下动脉开口的安全性和有效性，进一步明确适应证。方法73例因支架近端锚定区不足术中直接覆盖左锁骨下动脉开口患者中，44例左锁骨下动脉被完全覆盖（A组），29例左锁骨下动脉被部分覆盖（B组）。对比2组围手术期及随访期死亡率、神经系统并发症、左上肢缺血、内漏及二次干预治疗率等情况。结果患者均成功植入覆膜支架，共植入77枚覆膜支架，除4例植入2枚覆膜支架外，其余均仅植入1枚覆膜支架。A、B2组围手术期死亡率、神经系统并发症发生率、左上肢严重缺血发生率、内漏发生率及二次干预治疗率差异均无统计学意义[2．3％（1／44）比0％，4．5％（2／44）比0％，2．3％（1／44）比0％，22．7％（10／44）比20．7％（6／29），6．8％（3／44）比0％]（均P〉0．05）。平均随访（28±13）个月，A、B2组患者除左上肢缺血或近端闭塞的发生率差异具有统计学意义外[37．8％（14／37）比4．0％（1／25），29．7％（11／37）比0．0％；P〈0．05]，余差异均无统计学意义（均P〉0．05）。结论为了获得足够的锚定区，TEVAR术中选择性行左锁骨下动脉覆盖具有一定的安全性及可行性，但要严格把握其适应证，部分覆盖左锁骨下动脉更为安全可靠。Objective To explore the safety and efficiency of selective coverage of the left subclavian artery （LSA） during thoracic endovascular aortic repair（ TEVAR） with insufficient proximal landing zone. Methods All 73 patients underwent TEVAR in our hospital suffered intentional coverage of LSA. LSA was completely covered in 44 cases（ group A） and partially covered in 29 cases （group B）. Perioperative and follow-up mortality, neurologic complication, ischemia of the left upper limb, endoleak and secondary treatment were compared between two groups. Results All 77 stent-grafts were implanted for all patients with successful technique. Two stent-grafts were used for 4 patients while only one for each of the others. There was no statistical difference between group A and B regarding perioperative mortality, neurologic complication, serious ischemia of left upper limb, endoleak and secondary treatment. After follow-up of （28 ± 13 ） months, there were significant statistical differences between two groups only regarding ischemia and occlusion of left upper limb [ 37.8% （ 14/37 ） vs 4.0% （ 1/25 ）, 29.7% （ 11/ 37） vs 0.0% ; P 〈 0.05 ]. Conclusion Selective coverage of LSA ostium is safe and feasible for patients with insufficient landing zone during TEVAR, especially with partially coverage. Carefully preoperative analysis of the ima- ging is necessary.

关 键 词：胸主动脉 覆膜支架 腔内修复术 左锁骨下动脉 锚定区 

分 类 号：R445[医药卫生—影像医学与核医学]