右位主动脉弓合并Kommerell憩室伴或不伴迷走左锁骨下动脉的腔内治疗  

Endovascular repair of Kommerell diverticulum with or without aberrant left subclavian artery in right-sided aortic arch

作　　者：高培显[1] 李刚[1] 罗坤 袁海[1] 王默[1] 董典宁[1] 种振岳[1] 张十一[1] 吴学君[1] Gao Peixian;Li Gang;Luo Kun;Yuan Hai;Wang Mo;Dong Dianning;Zhong Zhenyue;Zhang Shiyi;Wu Xuejun(Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong University,Ji’nan 250021,China)

机构地区：[1]山东大学附属省立医院血管外科,济南250021

出　　处：《中华血管外科杂志》2020年第2期100-105,共6页Chinese Journal of Vascular Surgery

基　　金：国家自然科学基金(81670435);山东省重点研发计划(2017GSF18176)。

摘　　要：目的总结右位主动脉弓合并Kommerell憩室、伴或不伴迷走左锁骨下动脉患者行主动脉腔内修复术的治疗策略。方法回顾性分析2013年5月至2019年4月山东大学附属省立医院血管外科4例右位主动脉弓合并Kommerell憩室、伴或不伴迷走左锁骨下动脉的患者行胸主动脉腔内修复术的临床资料。结果前3例患者均为右位主动脉弓合并Kommerell憩室、伴迷走左锁骨下动脉。患者1于右锁骨下动脉送入交换导丝作为定位标记,在右前斜25°的工作位角度植入覆膜支架1枚,植入Ⅱ型Amplazer血管塞1枚封堵Kommerell憩室。患者2在右前斜77°的工作位角度植入覆膜支架1枚,经右腋动脉入路植入Viabahn覆膜支架1枚,以烟囱技术重建右锁骨下动脉。经左肱动脉入路应用Ⅱ型Amplazer血管塞封堵Kommerell憩室。患者3为右位主动脉弓合并Kommerell憩室、主动脉弓部夹层,术中经右股动脉入路植入覆膜支架1枚,近端平左颈总动脉后缘,分别经右腋动脉和右颈动脉植入Viabahn覆膜支架,采用烟囱技术重建右颈总动脉和右锁骨下动脉。术中见Ia型内漏,补救性植入后释放支架1枚。患者4为右位主动脉弓合并Kommerell憩室、不伴迷走左锁骨下动脉,在右前斜55°的工作位角度植入覆膜支架1枚。本组患者术后均无死亡、左上肢缺血或脑血管意外。结论右位主动脉弓合并Kommerell憩室、伴或不伴迷走左锁骨下动脉的主动脉畸形行主动脉腔内修复术治疗安全有效,需要结合患者病变特点选择个体化的治疗方案。Objective To summarize the endovascular procedures of Kommerell diverticulum(KD)with or without aberrant left subclavian artery(LSA)in right-sided aortic arch.Methods From May 2013 to April 2019,4 patients receiving endovascular treatments for the KD in right-sided aortic arch,with or without an aberrant LSA were retrospectively analyzed.Results The four patients all underwent endovascular aortic repair.The first patient received Amplatzer vascular plug embolization of the aberrant LSA and endovascular repair of the KD,with a 0.035-inch,260-cm stiff wire intentionally placed into the right subclavian artery(RSA)as a radiopaque marker delineating the proximal extent of the landing zone.The second one underwent endovascular aortic repair with a stent-graft implantation,embolization of the aberrant LSA and KD,and preservation of the RSA with chimney technique.The third patient underwent endovascular repair and the LSA,RSA and right carotid artery were preserved with chimney technique.Type Ia endoleak was found during the operation in this patient,and was treated with a stent graft implantation.The last patient who had right aortic arch with KD,without an aberrant LSA received endovascular repair without reconstruction of the LSA.There were no death,left arm ischemia,or neurological deterioration in all patients.Conclusion Endovascular treatment yields a relatively satisfactory outcome in patients of right-sided aortic arch with KD,with or without an aberrant LSA.The choice for each strategy should be based on the patients’individual anatomy and pathological features.

关 键 词：右位主动脉弓 右锁骨下动脉 覆膜支架 脑血管意外 右颈总动脉 省立医院 腔内治疗 血管外科 

分 类 号：R543.1[医药卫生—心血管疾病]