经皮微穿刺左锁骨下动脉体内重建在短近端锚定区胸主动脉腔内修复术中的应用  

Application of in situ needle puncture fenestration of left subclavian artery during thoracic endovascular aortic repair with the short proximal landing zone

作　　者：曾庆乐[1] 叶鹏[1] 马铭远 缪洪飞 陈勇[1] Zeng Qingle;Ye Peng;Ma Mingyuan;Miao Hongfei;Chen Yong(Division of Vascular and Interventional Radiology,Department of General Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Department of Vascular Interventional Radiology,Central Hospital of Shantou,Shantou 515031,China)

机构地区：[1]南方医科大学南方医院普通外科血管与介入专科,广州510515 [2]广东省汕头市中心医院血管介入科,515031

出　　处：《中华放射学杂志》2020年第10期992-997,共6页Chinese Journal of Radiology

摘　　要：目的探讨经皮微穿刺左锁骨下动脉体内重建在短近端锚定区胸主动脉腔内修复术(TEVAR)中的应用价值,评价左锁骨下动脉体内开窗术的可行性及安全性。方法回顾性收集2018年10月至2019年6月南方医科大学南方医院行经皮微穿刺左锁骨下动脉TEVAR支架体内开窗术的23例患者,其中胸主动脉夹层患者17例、胸主动脉瘤患者6例。在常规TEVAR术后,以预弯的21 G空芯套管穿刺针经左锁骨下动脉内侧段直接穿刺胸主动脉覆膜支架行体内开窗术,观察其成功率、临床疗效和并发症,术后1、3、6个月进行随访。结果23例左锁骨下动脉体内开窗术的技术成功率为100%,术后即刻胸主动脉造影见胸主动脉覆膜支架及左锁骨下动脉分支支架膨胀良好,周围无内漏发生。围手术期未见左锁骨上区血肿发生。1例患者术后3 d出现左侧少量气胸,未予特殊处理自愈。随访时间为(4.2±1.4)个月,复查胸主动脉增强CT未见支架近端逆撕及左锁骨下动脉分支支架周围内漏形成。结论在TEVAR的基础上行经皮微穿刺左锁骨下动脉重建是一种简单可行、安全高效的体内开窗手术。Objective To evaluate the feasiblity and safety of in situ fenestration during the endograft of thoracic endovascular aortic repair(TEVAR)via the left subclavian artery(LSA).Methods A total of 23 patients,including 17 patients with thoracic aortic dissection and 6 patients with thoracic aortic aneurysm,were respectively enrolled from October 2018 to June 2019 at Nanfang Hospital,Southern Medical University.All of the patients underwent in situ fenestration of LSA via the thoracic artery endograft following the TEVAR procedure.A 21 G preflex hollow needle was used to puncture the endograft from the medial segment of LSA for in situ feneatration.The success rate,clinical effect and complications were recorded on 1,3 and 6 months after in situ fenestration.Results The success rate was 100%in all the 23 patients with needle puncture in situ fenestration of LSA.The rechecked thoracic aorta angiography showed that both thoracic aortic main endograft and the LSA branch cover stent were well expanded,and there were no endoleaks occurred around the LSA branch cover stent.No hematoma was found in the supraclacicular fossa within all the perioperative period.A small pneumatothorax in the left pleural cavity which did not need treatment was being detected in 1 patient on the chest film 3 days after the procedure.The mean follow-uptime was(4.2±1.4)months.There were no retrograde tearing happened in the proximal end of the endograft,and no endoleak happened around the LSA branch cover stent either.Conclusion The technique of needle puncture fenestration of LSA via the thoracic artery endograft is considered as a simple,safe,and effective method of in situ LSA reconstruction.

关 键 词：主动脉瘤 胸 放射学 介入性 开窗术 左锁骨下动脉 穿刺术 

分 类 号：R654.3[医药卫生—外科学]