原位开窗重建弓部分支血管的中期疗效观察  

Midterm outcomes of in situ fenestration for aortic arch vessels

作　　者：孙国义[1] 贾森皓[1] 刘杰[1] 卢卫航 容丹 贾鑫[1] 张敏宏[1] 许永乐[1] 张宏鹏[1] 马晓辉[1] 熊江[1] 刘小平[1] 郭伟[1] Sun Guoyi, Jia Senhao, Liu Jie, Lu Weihang, Rong Dan,Jia Xin, Zhang Minhong, Xu Yongle, Zhang Hongpeng, Ma Xiaohui, Xiong Jiang, Liu Xiaoping, Guo Wei.(Department of Vascular Surgery, People＇s Liberation Army General Hospital, Beijing 100853, Chin)

机构地区：[1]解放军总医院血管外科,北京100853

出　　处：《中华普通外科杂志》2018年第3期193-195,共3页Chinese Journal of General Surgery

摘　　要：目的观察胸主动脉腔内修复术（thoracic endovascular aortic repair，TEVAR）术中原位开窗（in situ fenestration，ISF）技术重建弓上分支血管的中期临床疗效。方法对2012年2月至2014年12月，10例ISF重建主动脉弓部分支的TEVAR患者进行随访，其中胸主动脉瘤6例，B型主动脉夹层4例。观察全因死亡率，TEVAR术后内漏发生率，主体、分支支架完整性和通畅性。结果10例患者应用ISF重建11个分支动脉（10个左锁骨下动脉，1个左颈总动脉）。随访时间24-55个月，中位随访时间42．80个月。1例患者TEVAR术后2年非手术相关死亡。随访期间无内漏，支架无闭塞、受压；无脑梗死及左上肢缺血并发症。1例患者术后2年因主体支架远端假性动脉瘤形成，再行TEVAR治疗，二次干预率10％。结论TEVAR术中ISF重建弓部分支血管是安全可行的，中期疗效良好。Objective To evaluate midterm outcomes of thoracic endovascular aortic repair （TEVAR） with in situ fenestration （ISF） to revascularize the aortic arch vessels. Methods From Feb 2012 to Dec 2014, 10 patients underwent TEVAR with aortic arch vessels revascularized via ISF. There were 6 patients of thoracic aortic aneurysms （TAA） and 4 of type B aortic dissection （TBAD）. Patients were followed for all-cause mortality, endoleak of post-TEVAR, integrity and patency of aortic endograft and branch vessels. Results Totally 11 branch vessels [ 10 left subclavian arteries （ LSA）, 1 left common carotid artery （LCA） l via ISF were revascularized in 10 patients. Patients were followed-up for 24 - 55 mouths, mean of 42. 80 months. 1 TAA patient died in 2 years post-TEVAR unrelated to the operation. All fenestrations remained patent, and there were no endoleaks and no occlusion, compression, or fracture of stents. There were no postoperative strokes and left upper limbs ischemia. 1 patient had distal aortic endograft pseudoaneurysms formation in 2 years post-TEVAR and underwent reTEVAR treatment. Conclusion Aortic arch vessels revascularization via ISF in TEVAR is safe and feasible. Midterm outcomes is satisfactory.

关 键 词：主动脉疾病 血管成形术 原位开窗 颈总动脉 左锁骨下动脉 

分 类 号：R654.3[医药卫生—外科学]