单分支型主动脉支架治疗Stanford B型主动脉夹层11例分析  

Endovascular repair of Stanford B dissection with branched stent-graft:An analysis of 11 cases

作　　者：杨珏[1] 符伟国[1] 徐欣[1] 陈斌[1] 蒋俊豪[1] 岳嘉宁[1] 

机构地区：[1]复旦大学附属中山医院血管外科,上海200032

出　　处：《中国实用外科杂志》2014年第12期1167-1170,共4页Chinese Journal of Practical Surgery

摘　　要：目的总结单分支型主动脉支架在Stanford B型主动脉夹层的腔内隔绝治疗经验。方法 2013年7月至2014年2月复旦大学附属中山医院血管外科对11例近端破口距离左锁骨下动脉开口<20 mm的Stanford B型主动脉夹层应用一体化单分支型主动脉支架行腔内隔绝治疗,观察术后即时血管造影结果,术后1个月门诊随访,术后6个月行主动脉CT血管造影(CTA)检查。以动脉瘤相关存活率、手术成功率和分支支架通畅率为有效性终点指标,并观察相应的不良事件。结果 11例中10例术中支架释放成功,1例分支支架无法进入左锁骨下动脉而放弃。平均手术时间(130.0±36.0)min,围手术期无不良事件。随访期10例病人中无死亡,1例出现支架远端内漏,1例出现左锁骨下动脉支架闭塞,余支架封堵良好,夹层假腔均出现血栓化,假腔直径平均缩小12 mm。结论单分支型主动脉支架对于近端破口距左锁骨下动脉开口<20 mm的Stanford B型主动脉夹层是有效的腔内隔绝方法。Objective To summarize experience of thoracic endovascular aortic repair （TEVAR） in patients with proximal short landing zone with branched stent-graft. Methods A total of 11 patients with Stanford B dissection who underwent TEVAR with left subclavian artery（LSA）revascularization by single-branched stent-graft from July 2013 to February 2014 were retrospectively reviewed. Routine postoperative follow-up with computed tomography angiography （CTA） was performed to assess TEVAR and LSA patency,endoleak,dissection exclusion and complications in 1 and 6 months. Results TEVAR with single-branched stent-graft was successfully performed in 10 patients,and 1 patients failed by unsuccessful deployment of branched stent and replaced by another stent-graft with coverage of LSA. The mean operative time was（130.0 ± 36.0）minutes. No major complications occurred. All patients were followed up in 1 and 6 months postoperatively. TypeⅠendoleak was noted in 1 patient and 1 patient had an asymptomic LSA stent occlusion by CTA. Thrombosis formed in the aortic false lumen of the graft exclusion segment in all the patients,and the average diminution was 12mm. Conclusion Branched stent-graft is a feasible and effective option for LSA revascularization with proximal landing zone〈20 mm during TEVAR.

关 键 词：夹层 支架 腔内修复 CT血管造影 

分 类 号：R6[医药卫生—外科学]