胸主动脉腔内修复应用原位开窗保留弓上分支动脉技术  

In situ fenestration to preserve supra-aortic branch during thoracic endovascular aortic repair

作　　者：向一郎 吴子衡[1] 李栋林[1] 田路[1] 何杨燕 商弢[1] 张鸿坤[1] 

机构地区：[1]浙江大学医学院附属第一医院血管外科,浙江杭州310003

出　　处：《外科理论与实践》2017年第4期316-321,共6页Journal of Surgery Concepts & Practice

摘　　要：目的:回顾性分析胸主动脉腔内修复使用原位开窗保留弓上分支动脉技术的初步经验。方法 :分析我院从2016年7月至2017年2月行胸主动脉腔内修复术中原位开窗15例病人的临床资料。弓部假动脉瘤3例,主动脉夹层12例。结果:病人均成功实施胸主动脉腔内修复术。23支目标血管中21支成功开窗(91.3%)。3例病人同时进行头臂干、左颈总动脉及左锁骨下动脉三开窗,平均手术时间为(550.0±155.6)min。2例行左颈总动脉及左锁骨下动脉双开窗,平均手术时间为(405.0±275.8)min。10例行左锁骨下动脉单开窗,平均手术时间为(175.0±43.5)min。术中发生穿刺侧髂外动脉损伤1例,术后发生脑梗死1例。围手术期无死亡病例。平均住院(15.3±4.3)(8~26)d。平均随访(3.1±2.0)(1~7)个月。随访病人均无不适症状。13例病人(86.7%)复查CTA,均未发现夹层进展。开窗支架通畅在位,无内漏及其他支架并发症发生。结论:原位开窗技术有效扩大胸主动脉腔内修复治疗主动脉病变适应证,安全可行,有微创优势。Objective To summarize experience of in situ fenestration techniques during thoracic endovascular aortic repair（TEVAR） preserving supra-aortic branch vessels. Methods A total of 15 patients underwent TEVAR with an in situ stent graft fenestration technique from July 2016 to February 2017 in our hospital. Results All of the TEVAR procedures were completed successfully. Of the 23 target vessels, 21 vessels were successfully reconstructed using in situ fenestration with the success rate 91.3%. Three cases underwent in situ fenestration of brachiocephalic artery, left common carotid artery and left subclavian artery simultaneously. The operative time was（550.0 ±155.6） mins. Two patients had in situ fenestration of left common carotid artery and left subclavian artery during（405.0 ±275.8） mins. Ten cases were done only left subclavian artery with（175.0 ±43.5） mins. One case of external iliac artery injury was found during operation and1 case with cerebral infarction postoperatively. There was no peri-operative death. The length of stay was（15.3±4.3）（8-26）days. No symptom was found for all patients during the follow-up of（3.1±2.0）（1-7） months. Thirteen patients performed CTA examination and disease progression was not present. All the branch stent grafts were patent without endoleak or any other stent-associated complications. Conclusions In situ fenestration techniques could be used effectively and safely so as to enlarge the indication of TEVAR in the treatment of aortic disease with minimal invasion.

关 键 词：动脉瘤 夹层 支架 主动脉弓 腔内修复术 原位开窗 

分 类 号：R654.3[医药卫生—外科学]