胸主动脉夹层动脉瘤腔内隔绝术中左锁骨下动脉的处置  

Disposition of left subclavian artery in endovascular graft exclusion for thoracic aortic dissection

作　　者：赵志青[1] 景在平[1] 包俊敏[1] 赵珺[1] 冯翔[1] 陆清声[1] 王利丽[1] 

机构地区：[1]第二军医大学长海医院血管外科,全军血管外科研究所上海200433

出　　处：《第二军医大学学报》2002年第7期704-706,共3页Academic Journal of Second Military Medical University

基　　金：军队杰出人才基金资助项目 (98J0 0 5 ) ;上海市卫生系统百名优秀跨世纪学科带头人培养计划资助项目(97BR0 47) ;上海市科技发展基金攻关计划资助项目(0 0 44 190 2 9) ;长海医院学科攀登计划基金资助课题 .

摘　　要：目的 :探讨腔内隔绝术治疗 Stanford B型胸主动脉夹层动脉瘤时左锁骨下动脉开口的处理原则。方法 :对 116例接受腔内隔绝术治疗的 Stanford B型胸主动脉夹层动脉瘤患者进行回顾性分析。 结果 :116例患者中 6 2例左锁骨下动脉开口受到干扰 ,其中 2例完全遮蔽 ,19例有临床症状 ,而术前行颈外动脉 -椎动脉旁路者 ,完全遮蔽左锁骨下动脉后无不适症状。结论 :完全遮蔽左锁骨下动脉可引起左侧椎动脉的急性严重缺血造成严重的并发症 ,术前应根据夹层破口与左锁骨下动脉开口的距离 ,选择性实施左锁骨外动脉 -左椎动脉旁路术。Objective: To discuss the disposition principle of left subclavian artery in endovascular graft exclusion for Stanford B thoracic aortic dissection. Methods: Totally 116 patients of Stanford B thoracic aortic dissection treated with the endovascular graft exclusion were studied retrospectively. Results: Sixty two patients whose left subclavian arterial opening were disturbed, among them left subclavian arterial opening in 2 patients were occluded completely, 19 patients had clinic symptom. Patients received the bypass of external carotid to vertebral artery before the occlusion of the left subclavian arterial opening had no malaise symptom. Conclusion: The complete occlusion of the left subclavian arterial opening may cause acute ischemia of the left subclavian arterial and lead to severe complications. Before endovascular graft exclusion, the bypass of external carotid to vertebral artery should be chosen according to the distance between the opening of the left subclavian artery and the cleft of the dissection.

关 键 词：胸主动脉夹层动脉瘤 腔内隔绝术 左锁骨下动脉 治疗 

分 类 号：R543.16[医药卫生—心血管疾病]