预开窗技术保留弓上分支血管在TEVAR治疗术中的临床应用经验  

Clinical experience of preprocedural fenestrated technique during TEVAR for aortic arch disease to preserve supra-aortic branch

作　　者：孟庆友[1] 沈振亚[1] 黄浩岳[1] 余云生[1] 叶文学[1] 

机构地区：[1]苏州大学附属第一医院心血管外科苏州大学心血管病研究所,江苏苏州215006

出　　处：《外科理论与实践》2017年第4期322-326,共5页Journal of Surgery Concepts & Practice

摘　　要：目的:回顾性分析预开窗技术保留弓上分支血管在胸主动脉腔内修复(throacic endovascular aortic repair,TEVAR)治疗术中的初步临床经验。方法 :对2015年12月至2017年4月25例累及主动脉弓部病变病人实施TEVAR治疗。采用预开窗技术保留弓上分支动脉。应用3种方法处理:(1)窗口预留导丝法4例;(2)窗口4点标记法6例;(3)主动脉翻转效应结合2点标记法15例。其中单开窗22例,双开窗3例。分析技术成功率、血管通畅率、内漏发生率、并发症发生率和近期临床结果。结果:本研究技术成功率为92.0%(23/25),失败2例改行烟囱支架。术后血管造影示各开窗血管血流通畅,支架形态良好,少量近端内漏2例(8.0%)。手术时间0.5~3 h。无卒中和心肌梗死发生。随访20例(80.0%),随访时间(180.2±6.0)(15~390)d。血管通畅率为100%,无内漏。结论:应用预开窗技术保留弓上分支血管在TEVAR治疗中具有创伤小、成功率较高、并发症发生率及病死率较低等优点。需进一步随访远期疗效。Objectives The preprocedural fenestrated technique during thoracic endovascular aortic repair（TEVAR）for aortic arch disease to preserve supra-aortic branch were analyzed retrospectively. Methods From December 2015 to April 2017, 25 patients with aortic arch disease were treated by preprocedural fenestrated technique during TEVAR. There were three processing subtypes：（1） fenestrated stents with reserved wire in 4 cases;（2） fenestrated stents with four-point mark in 6 cases;（3）aortic turnover effect with two-point mark in 15 cases. Twenty-two cases were with one fenestration and3 cases with two fenestrations. Technical success, vascular patency, endoleak, complications, mortality and recent clinical results were evaluated. Results The technical success rate was 92.0%（23/25）. Two cases changed to chimney technique.Postoperative angiography revealed fenestrated vessels patency and stents shape well. Two cases with small proximal en-doleak were observed（8.0%）. Operative time ranged 0.5~3 h. No stroke or myocardial infarction occurred. Twenty cases（80%） had follow-up of the mean time（180.2±6.0）（15~390） d. The stent patency rate was 100% without endoleak. Conclusions The clinical application of preprocedural fenestrated technique during TEVAR for aortic arch disease to preserve supra-aortic branch was minimally invasive, high technique success rate with low rates of complications and mortality. Fur-ther follow-up study is needed to confirm long-term results of this technique.

关 键 词：胸主动脉腔内修复术 主动脉弓病变 预开窗技术 

分 类 号：R654.3[医药卫生—外科学]