Stanford B型夹层腔内修复术中左锁骨下动脉的处理  

Individual treatment of the left subclavian artery in endovascular repair for Stanford B dissection

作　　者：任伟[1] 王志维[1] 夏军[1] 周桢[1] 胡锐[1] 江万里[1] 

机构地区：[1]武汉大学人民医院心血管外科,430060

出　　处：《实用医学杂志》2014年第3期450-452,共3页The Journal of Practical Medicine

摘　　要：目的：总结腔ca修复术治疗StanfordB型主动脉夹层中不同左锁骨下动脉处理方法和经验。方法：2008年1月至2013年1月，共127例StanfordB型主动脉夹层患者行腔内修复术．左锁骨下动脉采取4种处理方式：完全不封闭31例、部分封闭25例、完全封闭38例和完全封闭后杂交手术重建33例。结果：1例行腔内修复手术时突发心肌梗塞死亡。所有患者支架成功释放，夹层近端破口封闭良好，重建血管通畅率达100％，近端I型ca漏1例，患者均未出现急性颅内缺血表现和左上肢缺血坏死发生。110例患者随访6～58个月，复查主动脉CTA示人3-血管通畅无内漏，无脑部及左上肢并发症，3例术后出现StanfordA型夹层开胸手术治愈。结论：应根据主动脉病变情况及双侧椎动脉发育差异采取个体化方式处理左锁骨下动脉。Objective To review experience and different treatment methods of the left subclavian artery in the endovascular repair for Stanford B aortic dissection. Methods From January 2008 to January 2013, 127 cases of Stanford B aortic disease were treated by endovascular repair. Left subclavian arteries were dealed with 4 kinds of methods ： completely opened （31 cases）, partially closed （25 cases）, completely closed （38 cases） and hybrid reconstruction after completely closed （33 cases）. Results One case suddenly died of myocardial infarction during endovscular operation. All stents were successfully released, proximal crevasse were perfectly closed, and reconstruction patency rate was 100% and only 1 case with proximal type I endoleak. No patient experienced acute intracranial manifestations and left upper limb ischemia. One hundred and ten of these cases were followed up for 6 to 58 months. The aortic CTA review in these patients showed that the grafts were patency, with no endoleak, and with no brain or left upper limb complications. Three cases of Stanford A dissection after EVR were cured undergoing thoracic surgery. Conclusion Left subclavian artery should be taken individual approach based on the aorta lesions and bilateral vertebral artery differences.

关 键 词：动脉瘤 夹层 STANFORD B型夹层 腔内修复 左锁骨下动脉 血管旁路 

分 类 号：R654[医药卫生—外科学]