复合手术治疗累及左锁骨下动脉的降主动脉病变  

Hybrid strategy for thoracic descending aorta disease involing left subclavian artery

作　　者：任长伟[1] 黄连军[1] 阳晟[1] 来永强[1] 许尚栋[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科中心,100029

出　　处：《心肺血管病杂志》2018年第2期126-129,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:评估一期覆膜支架置入合并腋-腋动脉人工血管转流治疗累及左锁骨下动脉的降主动脉病变的近期效果。方法:2009年4月至2014年8月,因降主动脉病变累及左锁骨下动脉在我院行一期杂交手术(右腋动脉-左腋动脉转流+降主动脉支架型人工血管置入术+左锁骨下动脉近端封堵术)共有20例(男性17例,女性3例)患者,对所有患者随访至2016年10月,随访时间26~87个月,平均(51.0±18.1)个月。评估30d内病死率,内漏发生率,转流血管远期并发症。结果:所有手术在杂交手术室完成,围手术期无死亡,2例因近端内漏行开胸手术,1例因远端新发破口行主动脉夹层腔内修复术。结论:一期杂交手术治疗累及左锁骨下动脉的降主动脉病变近期效果良好,但不适合破口位于主动脉弓部大弯侧紧邻左锁骨下动脉的B型主动脉夹层,这类患者容易发生近端内漏,左锁骨下动脉近端塞子的置入有效构成了转流血管两端的压力差,有利于转流血管的通畅。远期效果还需要大样本量的进一步随访。Objective： The objective of this study is to evaluate the early-term clinical result of the hybrid strategy without sternotomy for thoracic descending aorta disease involing left subclavian artery and to summarize our initial experience with this technique. Methods： From April 2009 to August 2014,a total of 20 consecutive patients（ 17 males,3 females） with thoracic descending aorta disease underwent hybrid（ TEVAR procedure combined with supra-arch branch vessels bypass） procedure in our center. Right axillary artery to left axillary artery bypass was performed. A plug（ P1416,Huayishengjie,Beijing China） was implanted into the proximal part of the left subclavian artery. All patients were followed up until October 2016,from 26 to 87 monthsmean（ 51. 0 ± 18. 1）. The mortality within 30 days、the endoleak after the hybrid procedure、and the stenosis or blockage of the bypass graft during the following-up period were assessed. Results： All patient were operated on in one-staged procedure in hybrid operating room. There was no death within 30 days. Two patients underwent open surgery because of endoleak and one patient underwent a second thoracic endovascular aortic repair for newly-formed intimal tear during the follow-up. Conclusion： Our early result suggest that one-staged hybrid procedure represents a suitable therapeutic option for thoracic aortic pathologies involing left subclavian artery.Such hybrid procedure was not advocated for type B aortic dissection which has a tear in the greater curvature side and is near to the left subclavian artery because of a high possibility of endoleak. The sealing of the proximal left subclavian artery could be in favor of the patent of the bypass graft. However,the promising early result need to be confirmed by longer follow-up and larger comparative series.

关 键 词：胸主动脉病变 复合手术 覆膜支架 

分 类 号：R54[医药卫生—心血管疾病]