台上预开窗腔内修复术治疗累及内脏动脉的胸腹主动脉病变的近中期结果分析  

Short-and mid-term results of the revascularization of visceral arteries by fenestrated endovascular aortic repair with physician-modified endograft

作　　者：罗光泽 戴向晨[1] 潘红瑞 陈永辉 秘家学 朱杰昌[1] 范海伦[1] 冯舟[1] 罗宇东[1] 张益伟[1] 胡凡果[1] Luo Guangze;Dai Xiangchen;Pan Hongrui;Chen Yonghui;Bi Jiaxue;Zhu Jiechang;Fan Hailun;Feng Zhou;Luo Yudong;Zhang Yiwei;Hu Fanguo(Department of Vascular Surgery,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院血管外科,天津300052

出　　处：《中华血管外科杂志》2020年第2期94-99,共6页Chinese Journal of Vascular Surgery

基　　金：天津市科技支撑重点项目(16YFZCSY01080)。

摘　　要：目的评估台上预开窗主动脉腔内修复术治疗累及内脏动脉的胸腹主动脉病变近中期的安全性及有效性。方法收集2013年8月至2018年10月天津医科大学总医院34例术中应用开窗腔内修复术治疗累及内脏动脉的胸腹主动脉病变患者的临床资料。分析术中器械释放成功率、并发症率、死亡率,以及围术期和随访期并发症率、死亡率及临床驱动的靶病变再手术率。结果34例患者中共84条内脏分支通过开窗或开槽重建,其中有77条分支(91.7%)植入支架,包括33条分支植入裸支架,44条分支植入覆膜支架。器械释放成功率为97.1%(33/34),术中Ⅰb型内漏1例,Ⅲ型内漏1例,并发症率5.8%(2/34),无术中死亡病例。术后30 d死亡率为2.9%(1/34),CTA发现Ⅱ型内漏1例、Ⅱ型合并Ⅲ型内漏2例,肾功能不全2例,新发并发症率14.7%(5/34)。平均随访时间16.5(2~54)个月。随访至12个月患者23例,新发非主动脉原因死亡1例,总体死亡率为5.9%(2/34);右侧副肾动脉闭塞1例,新发并发症率为4.3%(1/23)。随访至24个月患者9例,无新发死亡,Ⅰb型内漏1例,新发并发症率为11.1%(1/9),临床驱动的靶病变再手术率为11.1%(1/9)。结论台上预开窗腔内修复术治疗累及内脏动脉的胸腹主动脉病变患者的近、中期结果安全、有效。Objective To evaluate the safety and the efficacy of fenestrated endovascular aortic repair(f-EVAR)on table in the treatment of thoracic and abdominal aortic lesions involving visceral arteries.Methods Clinical data of 34 cases of thoracic and abdominal aortic lesions involving visceral arteries treated with f-EVAR in Tianjin Medical University General Hospital from August 2013 to October 2018 were collected.Retrospective analysis of intraoperative delivery success rate,complication rate and mortality,as well as perioperative and follow-up complication rates,mortality,and lesion reoperation rates.Results A total of 84 visceral branches were reconstructed by fenestration or slotting in 34 patients.Among them,77 branches(91.7%)were implanted in the stent,including 33 bare stents and 44 stent grafts.The success rate of device release was 97.1%(33/34).There were intraoperative I b type endoleak in 1 case,typeⅢendoleak in 1 case,and complication rate was 5.8%(2/34).The mortality rate was 2.9%(1/34)at 30 days after operation.The CTA results showed that there were 1 case of typeⅡendoleak,2 cases of typeⅢendoleak,2 cases of renal insufficiency,and the newly onset complication rate was 14.7%(5/34).One of them was treated with reintervention.The average follow-up time was 16.5(2~54)months.Of the 23 patients who were followed up to 12 months,1 suffered non-aortic death,with an overall mortality rate of 5.9%(2/34).One patient had a right renal artery occlusion,and the complication rate was 2.9%(1/34).Nine patients were followed up to 24 months,no death was observed.There was 1 case of typeⅠb endoleak,so the newly onset complication rate was 11.1%(1/9),and the rate of lesion reoperation was 11.1%(1/9).Conclusion Intraoperative f-EVAR technology is safe and effective in the short-and mid-term outcomes.

关 键 词：胸腹主动脉疾病 内脏动脉 主动脉腔内修复术 开窗支架 

分 类 号：R654.3[医药卫生—外科学]