21例锁骨下动脉瘤(SAA)腔内诊治经验  

The endovascular treatment of 21 cases of suclavian artery aneurysms(SAA)

作　　者：梁双超[1] 王利新 史振宇 唐骁 严栋 郭大乔 符伟国 LIANG Shuang-chao;WANG Li-xin;SHI Zhen-yu;TANG Xiao;YAN Dong;GUO Da-qiao;FU Wei-guo(Department of Vascular Surgery,Yijishan Hospital,Wuhu 241100,Anhui Province,China;Department of Vascular Surgery,Zhongshan Hospital-Vascular Surgery Institute,Fudan University,Shanghai 200032,China)

机构地区：[1]皖南医学院弋矶山医院血管外科,芜湖241001 [2]复旦大学附属中山医院血管外科-复旦大学血管外科研究所,上海200032

出　　处：《复旦学报（医学版）》2018年第6期840-845,共6页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(81570438)~~

摘　　要：目的总结锁骨下动脉瘤(subclavicular artery aneurysm,SAA)患者腔内治疗的效果。方法复旦大学附属中山医院血管外科2013年1月至2016年6月共诊治SAA患者21例,男11例,女10例,平均年龄(39±9)岁。所有SAA患者均行腔内治疗,回顾分析围手术期和术后效果及不良事件。结果技术成功率为100%。术中1例SAA患者支架植入后,近端Ⅰ型内漏明显,改行平行支架植入术;2例Ⅱ型内漏和2例SAA瘤腔巨大分别行侧支和瘤腔钢圈栓塞;中位随访时间19(6～42)个月。随访期间3例SAA患者发生支架内狭窄,1例右SAA患者在释放支架时未覆盖锁骨下动脉开口,在第2年出现支架近端严重狭窄;2例患者SAA位于锁骨下动脉第3段,左右各1例,分别在第2年和第3年出现支架远端严重狭窄。患者2年和3年支架通畅率分别为90.5%和85.7%。结论腔内治疗SAA操作简单,效果明确;右SAA治疗中应在右锁骨下动脉和右颈总动脉分叉处的切线位角度,使分叉部位完全展开,尽量覆盖开口;对于短瘤颈平行支架植入效果较好;锁骨下动脉瘤位于第3段时,术后易出现支架内狭窄,要注意远期随访。Objective To evaluate endovascular treatment of subclavian artery aneurysm(SAA)retrospectively. Methods Between Jan.,2013 and Jun.,2016,21 cases of SAA(11 males and 10 females) were admitted in the Department of Vascular Surgery,Zhongshan Hospital,Fudan University,with the average age of(39±9)years.All patientes underwent endovascular treatment.We analyzed the perioperative and postoperative effect and adverse events retrospectively. Results The technique successful rate of endovascular repair was 100%.One case of SAA patient occurred proximal typeⅠ endoleak after stent implantation,then unerdwent parallel stent implantation and 2 cases of SAA patients appeared typeⅡendoleak,and2 cases of SAA patients of a huge tumor cavity underwent line of collateral and tumor cavity embolization respectively.The mean follow-up was 19(6-42)months.During the follow-up,3 cases of SAA patients appeared in-stent stenosis,1 case had not covered the subclavian artery opening position,3 patients appeard stent stenosis;2 cases located in the third paragraph of subclavian artery(1 case around each)appeared in-stent stenosis in2 years and3 years,respectively.The 2-year and 3-year stent patency rate were 90.5%and 85.7%. Conclusions Endovascular treatment of SAA is effective and easy to implement.In the endovascular treatment of SAA,we need to make the fork parts fully extended in the right subclavian artery and right common carotid artery bifurcation of tangent angle,and cover the subclavian artery opening position.The subclavian artery aneurysms located in the third paragraph are easy to appear stent stenosis.We should pay attention to the long-term follow-up.

关 键 词：动脉瘤 锁骨下动脉 腔内修复 

分 类 号：R543.4[医药卫生—心血管疾病]