不同病变累及主动脉弓部区域的原位开窗胸主动脉腔内修复分支重建的疗效  

The effect of different lesions involved branch reconstruction in the aortic arch region in situ fenestration thoracic endovascular aortic repair

作　　者：刘华[1] 张军[1] 刘斌[2] 罗玲[1] 林称意[1] 郭家龙[1] 罗卫民[1] 程栋梁[1] 原野[1] 张群献[1] Liu Hua;Zhang Jun;Liu Bin;Luo Ling;Lin Chenyi;Guo Jialong;Luo Weimin;Cheng Dongliang;Yuan Ye;Zhang Qunxian(Department of Thoracic and Cardiac Great Vascular Surgery,the Affiliated Taihe Hospital of Hubei Unieversity of Medicine,Shiyan 442000,Hubei,China;Central Department of Neurology,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,Hubei,China)

机构地区：[1]十堰市太和医院(湖北医药学院附属太和医院)心脏大血管外科,湖北十堰442000 [2]华中科技大学同济医学院附属同济医院中法院区神经内科,湖北武汉430000

出　　处：《血管与腔内血管外科杂志》2020年第6期501-507,共7页Journal of Vascular and Endovascular Surgery

基　　金：2019湖北省卫生健康委科研立项项目(WJ2019F062);十堰市太和医院科研项目(2019JJXM012)。

摘　　要：目的探讨不同病变累及主动脉弓部区域的原位开窗胸主动脉腔内修复(TEVAR)分支重建的疗效。方法选取2016年1月至2019年11月十堰市太和医院(湖北医药学院附属太和医院)收治的主动脉弓病变累及分支血管的34例患者临床资料。主动脉弓部病变根据Ishimaru法进行分区,累及Z1区5例,Z2区17例,Z3区12例。观察原位开窗TEVAR技术对不同病变累及主动脉弓部重建分支血管的临床治疗效果及围手术期并发症情况。术后1个月及12个月主动脉CT血管成像(CTA)复查不同病变区域主动脉弓部TEVAR术后鸟嘴情况。结果 34例患者行原位开窗TEVAR重建主动脉弓分支血管隔绝主动脉弓部病变,手术成功率100%,左锁骨下动脉原位开窗26例,左颈总动脉原位开窗6例,左颈总动脉加左锁骨下动脉原位开窗2例;左锁骨下动脉重建分支血管28支、左颈总动脉重建分支血管8支;脑梗死2例,谵妄3例,近端逆撕2例,Ⅰa型内漏1例,鸟嘴2例。主动脉CTA复查显示,术后1个月和12个月不同病变区域主动脉弓部TEVAR术后鸟嘴角度比较,差异有统计学意义(P<0.05),Z3区鸟嘴角度最大,高于Z1和Z2区(P<0.05)。结论不同病变累及主动脉弓部左颈总、左锁骨下动脉分支血管,采用原位开窗TEVAR分支血管重建,神经系统并发症及支架相关并发症发生率低,近期治疗效果满意,中远期有待进一步随访。Objective To observe effect of different lesions involved branch reconstruction in the aortic arch region in situ fenestration thoracic endovascular aortic repair(TEVAR). Method From January 2016 to November 2019, 34 patients with aortic arch disease involving branch vessels were selected from the Affiliated Taihe Hospital of Hubei University of Medicine. According to the Ishimaru method, aortic arch lesions were divided into Z1 area in 5 cases, Z2 area in 17 cases and Z3 area in 12 cases. To observe the clinical effects and perioperative complications of in situ fenestration TEVAR in aortic arch reconstruction with different lesions. At 1 month and 12 months after operation, computed tomography angiography(CTA) of aorta was performed to check the bird’s beak of aortic arch in different lesion areas after TEVAR. Result In 34 cases, the patients were reconstructed the branch vessels of the aortic arch by in situ fenestration TEVAR. The success rate was 100%. In situ fenestration of left subclavian artery was performed in 26 cases, of left common carotid artery in 6 cases, of left common carotid artery plus left subclavian artery in 2 cases, of left subclavian artery reconstruction branches in 28 cases, of left common carotid artery reconstruction branches in 8 cases. There were 2 cases of cerebral infarction, 3 cases of delirium, 2 cases of proximal reverse tear, 1 case of type Ia endoleak and 2 cases of bird’s beak. Aortic CTA reexamination showed that there was a significant difference in the bird’s beak angle of aortic arch in different lesion areas 1 month and 12 months after operation(P<0.05). The bird’s beak angle in Z3 area was the highest, which was higher than that in Z1 and Z2 areas(P<0.05). Conclusion Different lesions involved the aortic arch in the left common carotid artery and the left arteria subclavia were repaired by in situ fenestration TEVAR. The incidence of nervous system complications and stent related complications was low, the short-term treatment effect was satisfactory, and furth

关 键 词：主动脉弓 血管重建 原位开窗 胸主动脉腔内修复 

分 类 号：R543[医药卫生—心血管疾病]