一体单分支支架治疗主动脉弓部复杂病变  

Endovascular repair of complex aortic arch lesion with single branched stent graft

作　　者：孟维鑫[1] 邱冬云[1] 董晟 郭爱林[1] 孙博[1] MENG Weixin;QIU Dongyun;DONG Sheng;GUO Ailin;BO Sun(Department of Cardiovascular Surgery,The First Affiliated Hos-pital of Harbin Medical Unicer sly,Haerbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院心脏大血管外科

出　　处：《心肺血管病杂志》2019年第9期946-951,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：黑龙江省卫生计生委科研课题(2018381);哈医大一院科研创新基金(2018Y016)

摘　　要：目的:观察一体分支支架治疗主动脉弓部复杂病变的效果。方法:回顾分析本中心2018年1月至2019年3月共17例主动脉弓部复杂病变患者一体支架治疗情况,所有患者夹层破口或溃疡距离左锁骨下动脉<20 mm,患者术后3个月行主动脉CTA检查,观察支架形态,分支通畅情况,内漏情况等,和患者相关不良事件,并对比术前和术后CTA参数,用配对t检验评估真假腔变化情况。结果:16例(94.1%)成功置入一体分支支架,平均手术时间为(145.0±36.0)min,1例慢性B型夹层患者分支支架术中脱出,再次常规支架补救,封闭左锁骨下动脉,患者术后顺利未出现脑缺血和左侧肢体缺血症状。1例患者出院时CTA提示主动脉良好,出院后2个月因情绪激动,出现血压波动,复查CTA发现逆撕A型夹层,再次常规开胸手术,手术效果良好。其余患者术后3个月随访,无死亡和不良事件,支架主体段主动脉真腔较术前扩大明显(P<0.05),非支架段主动脉真腔扩大不明显(P>0.05),但主动脉整体无明显扩张。结论:一体单分支支架用于治疗锚定区不足的主动弓部病变,效果良好,但这中远期相关疗效还需要得进一步随访观察,该一体支架输送系统还需要改进,并且Ⅲ型主动脉弓患者慎重应用该技术。Objective: We aim to observe the outcomes of surgical treatment for complicated aortic arch lesion with branched stent-graft. Methods: Seventeen patients who underwent the implantation of branched stent-graft for complicated aortic arch lesion with the diameter less than 20 mm between the left subclavian artery ostium and the intimal tear or the aortic ulcer, were analyzed retrospectively. The morphology and patency of branched stent-graft, the postoperative adverse events, and the endoleak were evaluated with computered tomography angiography(CTA) 3 months after surgery. Pre-and post-operative result, especially the obliteration of false lumen after operation, were compared with paired t-test. Results: Sixteen cases(94.1%) were successfully treated with branched stent-graft with mean operation time(145.0±36.0) min. One patient with type B aortic dissection who underwent a redo surgery for the stent dislocation, a new stent implanted for closure of subclavian artery ostium, did not suffered from cerebral and left limb ischemia after operation. One patient who had an uneventful recovery at one-month follow-up after surgery, was diagnosed type A dissection at two-months follow-up caused by uncontrolled blood pressure and the emergent redo operation was performed with excellent postoperative result. Others had uneventful recovery without adverse events at three-months follow-up. The true lumen was increased(P<0.05)significantly in the aortic segment that was implanted with stent and insignificantly(P>0.05)in that without implantation of stent. There was no postoperative aneurysm happened for all patients. Conclusions: Thoracic endovascular repair(TEVAR) with branched stent-graft applied specifically to complicated aortic arch lesion without enough anchor area demonstrates excellent early outcome, however, the long-term follow-up is required. Branched stent-graft should be prudently implanted in patients with type III aortic arch and further improvement required.

关 键 词：一体分支支架 主动脉弓 腔内修复 

分 类 号：R54[医药卫生—心血管疾病]