台上预开窗覆膜支架置于Z1和Z0区的全腔内技术治疗主动脉弓部疾病  

On table fenestrated stent graft in zone 0 and zone 1 for aortic arch diseases

作　　者：范海伦[1] 朱杰昌[1] 戴向晨[1] 罗宇东[1] Phasakorn Noiniyom 冯舟[1] 张益伟[1] 胡凡果[1] Fan Hailun;Zhu Jicchang;Dai Xiangchen;Luo Yudong;Phasakorn Noiniyom;Feng Zhou;Zhang Yiwei;Hu Fanguo(Department of Vascular Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院血管外科,300052 [2]泰国Yala中心医院血管外科

出　　处：《中华普通外科杂志》2018年第12期1018-1021,共4页Chinese Journal of General Surgery

摘　　要：目的评估应用台上预开窗覆膜支架置于Z1和Z0区的胸主动脉腔内修复术治疗主动脉弓部疾病的可行性。方法回顾性分析2015年11月至2018年3月13例因主动脉弓部疾病行台上体外开窗胸主动脉腔内修复术患者的临床资料。结果男11例,女2例,中位年龄59(33。81)岁。覆膜支架置于Z0区的5例,Z1区8例。除3例急诊手术外均为择期手术。手术技术成功率92.3%。院内死亡率7.7%(1/13)。元围手术期神经系统并发症及截瘫。1例术后出现左下肢缺血及急性肾功能衰竭,开放取栓及透析后改善。平均住院时间为9.0(4~35)d。中位随访时间为11.5个月(1~19个月),1例支架位于ZO区的患者术后40d发生夹层逆撕,转为开放手术。其余患者开窗分支血管通畅、无开窗相关Ⅰ和Ⅲ型内漏。结论覆膜支架置于Z1和Z0区的台上预开窗胸主动脉腔内修复术治疗主动脉弓部疾病是可行的。Objective To evaluate fenestrated thoracic endovascular aortic repair (f-TEVAR)using fenestrated stent graft on table in zone 0and zone 1for aortic arch diseases.Methods 13 patients undergoing f-TEVAR by using physician modified fenestrated stent grafts (PMSGs)on table in zone 0and zone 1for aortic arch diseases between Nov 2015and Mar 2018were retrospectively reviewed. Results The median age was 59 years(range,33-81 years).PMSGs were deployed from Z0 in 5 patients and Z1in remaining 8 patients.All but 3 patients underwent elective procedure.The technical success rate was 92.3%.Overall mortality was 7.7%(1/13).There were no perioperative neurologic complications and paraplegia.One patient suffering from acute left leg ischemia and renal failure recovered after open embolectomy and dialysis.Median length of stay was 9.0 days (range,4-35 days).12patients were survival at a median follow-up of 11.5 months (range,1.0-19.0 months).Retrograde dissection occurred in one patient and resolved after open repair.During follow up,all target vessels remained patent,with no fenestration-related type Ⅰ or Ⅲ endoleaks.Conclusions f-TEVAR using modified fenestrated stent grafts on table in Z0 and Z1 is feasible for the treatment of aortic arch diseases.

关 键 词：主动脉疾病 血管成形术 开窗支架 

分 类 号：R654.3[医药卫生—外科学]