原位开窗重建左锁骨下动脉在胸主动脉腔内修复术中的应用  

Application of in Situ Fenestration to Recanalize Left Subclaivian Artery in Endovascular Repair of Thoracic Aorta

作　　者：陈浩[1] 肖占祥[1] 戚悠飞[1] 曾朝凡 刘飒华[1] 张文波[1] 李振振[1] 吴鸿飞[1] Chen Hao;Xiao Zhanxiang;Qi Youfei(Department of Vascular Surgery,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院血管外科

出　　处：《中国微创外科杂志》2020年第1期58-61,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨利用穿刺破膜技术进行原位开窗的可行性及效果。方法回顾性分析2014年7月~2018年1月10例原位开窗胸主动脉腔内修复术(thoracic endovascular repair,TEVAR)的资料,其中5例胸主动脉瘤,5例主动脉夹层。在覆膜支架封盖左锁骨下动脉后,利用打磨过的导丝硬头进行穿刺破膜、球囊扩张,重建左锁骨下动脉血流通路。结果9例开窗成功,1例胸主动脉瘤开窗失败,改行烟囱支架植入。开窗成功的9例术后随访13~53(29.8±16.1)月,左锁骨下动脉血流通畅,无内漏发生。结论利用穿刺破膜技术行原位开窗的技术简单,经济,有效,适用于累及左锁骨下动脉的胸主动脉瘤和主动脉夹层的治疗。Objective To study the feasibility and clinical effect of in situ fenestration by fabric puncture and tearing in thoracic endovascular repair(TEVAR).Methods The data of 10 cases of TEVAR and in situ fenestration were retrospectively analyzed,including 5 cases of thoracic aortic aneurysm and 5 cases of aortic dissection.After occluding the subclavian artery with the stent,the left subclavian artery was reconstructed by puncture and balloon dilatation with the hard head of the polished guide wire.Results Nine patients received successful fenestration in TEVAR,and one case of thoracic aortic aneurysm was changed from fenestration to chimney stenting.Postoperative review for 13-53 months(mean,29.8±16.1 month)in the 9 successful cases showed the blood flow of left subclavian artery was unobstructed without internal leakage.Conclusions The technique of in situ fenestration by fabric puncture and tearing is simple,economical and effective.It is suitable for the treatment of thoracic aortic aneurysm and aortic dissection involving left subclavian artery.

关 键 词：主动脉夹层 胸主动脉瘤 腔内修复术 原位开窗技术 

分 类 号：R65[医药卫生—外科学]