双向入路对吻覆膜支架技术在无名动脉分叉部附近假性动脉瘤中的应用  

Management of pseudoaneurysm near the bifurcation of innominate artery with kissing cover stents technique

作　　者：原野 胡双龙 胡亚立 卢辉俊 Yuan Ye;Hu Shuanglong;Hu Yali;Lu Huijun(Department of Vascular Surgery,the Affiliated Wuxi People’s Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院血管外科,214023

出　　处：《中华放射学杂志》2020年第9期882-885,共4页Chinese Journal of Radiology

摘　　要：目的探讨双向入路对吻覆膜支架(Kissing-stents)技术治疗无名动脉分叉部附近(距分叉部<1 cm)假性动脉瘤的可行性、安全性和有效性。方法回顾性分析2013年5月至2018年8月南京医科大学附属无锡人民医院收治的10例无名动脉分叉部附近假性动脉瘤患者的临床资料,男6例,女4例,年龄25.0~77.0岁,中位年龄50.5岁。所有患者均采用Viabahn覆膜支架配合Kissing-stents技术进行腔内修复治疗,观察其围手术期不良反应,并对患者进行随访,评估支架位置和通畅情况。结果损伤部位在无名动脉远端2例,无名动脉分叉部5例,右颈总动脉根部2例,右锁骨下动脉根部1例。4例损伤部位距分叉部5 mm以内,1例距分叉部8 mm。所有患者均顺利完成手术,手术时间100.0~150.0(122.0±14.9)min,术后住院时间4.0~9.0(6.3±1.5)d。术中右锁骨下动脉均植入8 mm×100 mm Viabahn覆膜支架,右颈总动脉均植入10 mm×100 mm Viabahn覆膜支架,围手术期未出现严重并发症。术后随访时间12~24个月,随访期间彩色超声多普勒和颈动脉CT血管成像显示支架位置正常,血流通畅,无闭塞、移位等,Viabahn覆膜支架在无名动脉近心端均保持齐平。结论Viabahn覆膜支架配合Kissing-stents技术是无名动脉分叉部附近假性动脉瘤安全有效的治疗方法。Objective To discuss the feasibility,safety and efficacy of kissing cover stents technique in the management of pseudoaneurysm near the bifurcation of innominate artery(the distance<1 cm).Methods A retrospective study of 10 patients with pseudoaneurysm near the bifurcation of innominate artery were performed in theAffiliated Wuxi People’s Hospital of Nanjing Medical University from May 2013 to August 2018.There were 6 males and 4 females,aged from 25.0 to 77.0 years old,with a median age of 50.5 years old.All patients were treated with Viabahn stents combined with kissing stents.The adverse reactions were observed during the perioperative period,and the patients were followed up to evaluate the stents position and patency.Results Among 10 patients,2 were in the distal of innominate artery,5 were in the bifurcation of innominate artery,2 were in the root of right common carotid artery and 1 was in the origin of right subclavian artery.The distance from the injury site to the bifurcation of innominate artery was less than 5 mm in 4 cases and 8 mm in 1 case.All of them were successfully treated with Viabahn stents combined with kissing stents.Operation time ranged from 100.0 to 150.0(122.0±14.9)min.The postoperative hospitalization time was(6.3±1.5)d,ranged from 4.0 to 9.0 d.During the operation,8 mm×100 mm Viabahn stents were implanted in the right subclavian artery and 10 mm×100 mm Viabahn stents were implanted in the right common carotid artery.There were no severe adverse reactions during the perioperative period.Follow-up time ranged from 12 to 24 months.During the follow-up,color Doppler ultrasound and carotid CT angiography showed that the stents were in appropriate position,the blood flow was unobstructed,and there was no occlusion and displacement of stents.Viabahn stents remained at the level of proximal end of the innominate artery.Conclusion Viabahn stents combined with kissing stents is a safe and effective treatment for pseudoaneurysm near the bifurcation of innominate artery.

关 键 词：头臂干 动脉瘤 假性 支架 放射学 介入性 

分 类 号：R654.3[医药卫生—外科学]