主动脉夹层腔内隔绝术中支架移位的处理  

Treatment of stent displacement during endovascular graft exclusion for aortic dissection

作　　者：韩冬[1] HAN Dong(Thoracic surgery of Xuzhou First People's Hospital of Jiangsu,Jiangsu Xuzhou 221002,China)

机构地区：[1]江苏省徐州市第一人民医院胸心外科,江苏徐州221002

出　　处：《中西医结合心血管病电子杂志》2018年第8期64-65,共2页Cardiovascular Disease Electronic Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的讨论主动脉夹层腔内隔绝术中支架移位的处理方法。方法选取我院2014年5月至2017年5月接诊的进行主动脉夹层腔内隔绝术中支架移位的患者12例作为本次研究对象,对所有患者的临床资料进行回顾性分析,其中有7例患者发生支架后移,包括支架半释放前移位1例、球囊扩张中支架后移3例、支架释放后撤销过程中支架后移3例;5例患者为支架前移,包括支架前移阻塞左颈总动脉3例、支架前移阻塞左锁骨动脉2例。结果 12例支架前移的患者均采用支架向前推或放置cuff缓解,所有患者均安全度过围术期,支架前移阻塞锁骨下动脉的患者有1例术后因脑梗塞死死亡;有覆盖左颈动脉的3例患者,有1例采用抓捕器牵拉导管,有2例采用球囊扩张器。结论主动脉夹层腔内隔绝术中支架位移与术者操作技术、解剖因素、支架设计等因素有关,发生前移比较少见,但是对患者的影响更大,除了可以使用球囊拖拽以外,还可以采用抓捕器牵拉左锁骨下动脉进行补救。Objective To discuss the treatment of stent dislocation in aortic dissection.Methods Twelve patients who underwent stent dissection in aortic dissection from May 2014 to May 2017 in our hospital were selected as subjects for this study.The clinical data of all patients were retrospectively analyzed.Among them,7 cases experienced stent retrusion,including 1 case before stent release,1 case with balloon expansion,3 cases with stent retraction,3 cases with stent retraction after stent release,and 5 cases with stent advance.Including stent arthrodesis blocking the left common carotid artery in 3 cases,stent anterior blockage of the left clavicular artery in 2 cases.Results All 12 patients with stent anterior motion were treated with stents or cuffs.All patients survived the perioperative period.One case of patients with stent anterior blockage of the subclavian artery died of cerebral infarction.There were 3 patients covered with the left carotid artery.One patient used a grasper to pull the catheter,and two patients used a balloon dilator.Conclusion Stent displacement during aortic dissection is associated with factors such as operator technique,anatomical factors,and stent design.Precursions are relatively rare,but have a greater impact on the patient,with the exception of the use of balloon dragging.You can also use a catcher to pull the left subclavian artery for remediation.

关 键 词：主动脉夹层 腔内隔绝术 支架位移 

分 类 号：R732.2[医药卫生—肿瘤]