合并迷走右锁骨下动脉B型主动脉夹层个体化腔内治疗  

Individual thoracic endovascular aortic repair strategy for management of type B aortic dissection with an aberrant right subclavian artery

作　　者：郑智[1] 查正彪[1] 刘纯[1] 李利艳[1] 魏翔[1] 潘友民[1] ZHENG Zhi;ZHA Zhengbiao;LIU Chun(Department of Cardiothoracic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Scienceand Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,武汉430030

出　　处：《临床外科杂志》2020年第11期1012-1015,共4页Journal of Clinical Surgery

摘　　要：目的探讨个体化腔内治疗(TEVAR)策略在合并迷走右锁骨下动脉(ARSA)的B型主动脉夹层治疗中的应用。方法 2015~2017年合并ARSA的B型主动脉夹层病人12例,根据夹层第一破口与ARSA、左锁骨下动脉(LSA)的距离关系及椎动脉优势类型进行临床分型并制定个体化TEVAR策略。结果本组12例病人个体化TEVAR策略包括单纯TEVAR2例,TEVAR+LSA开窗2例,TEVAR+LSA小分支支架4例,TEVAR+ARSA开窗1例,TEVAR+颈部杂交(左颈总动脉-LSA)1例,TEVAR+开胸经升主动脉杂交2例(包括重建ARSA1例,重建LSA+ARSA1例)。手术成功率100%。围术期无逆撕、神经系统并发症、截瘫等。术后随访1例ARSA开窗病人出现轻度内漏,一直保守治疗未进展。其他病人未发生主动脉相关并发症及神经系统并发症,重建的LSA、ARSA血流通畅。1年随访无死亡病例。结论个体化TEVAR策略治疗合并ARSA的B型主动脉夹层近期效果良好,远期疗效仍有待长期随访结果证实。Objective To elucidate the application of individual thoracic endovascular aortic repair(TEVAR)strategy in Stanford type B aortic dissection with an aberrant right subclavian artery(ARSA).Methods Type B aortic dissection patients with ARSA were studied.An individual TEVAR strategy was made according to the distance between primary entry tear and ARSA and left subclavian artery(LSA),and left or right vertebral artery predominance type.Results Twelve cases were enlisted in this study.Individual TEVAR strategy included:two cases of simple TEVAR,two cases of TEVAR+LSA fenestration,four cases of TEVAR+ single branched stent graft for LSA,one case of TEVAR+ARSA fenestration,one case of TEVAR+ hybrid operation(left carotid artery to LSA bypass),two cases of TEVAR+ open chest hybrid operation(ascending aorta to ARSA bypass in one patient,and ascending aorta to LSA and ARSA bypass in the other).During perioperative period,no retrograde dissection of ascending aorta,or neurologic complication,or paraplegia was recorded.During one year follow up,a mild type I endoleak was noted in one patient with ARAS fenestration,and remained stable.No other aorta-related or neurologic complication was recorded.LSA and ARSA with fenestration or branched stent graft remained patent.No death was noted during one year follow up.Conclusion Individual TEVAR strategy is a safe and effective technique in management of type B aortic dissection with ARSA.However,further large-scale follow-up studies are required to verify its long-term efficacy.

关 键 词：STANFORDB型主动脉夹层 迷走右锁骨下动脉 腔内治疗 个体化治疗 

分 类 号：R654.3[医药卫生—外科学]