体外支架双开窗技术在Stanford B型主动脉夹层伴迷走锁骨下动脉患者腔内治疗中的应用  

Application of extracorporeal aortic stent double pre-fenestration technology in endovascular repair of Stanford type B aortic dissection associated with aberrant subclavian artery

作　　者：王亮[1,3] 张玉京[1] 白雷[1] 杨永滨[4] 吉林[4] 王海茜[2] 刘江龙 李晓东[1] WANG Liang;ZHANG Yujing;BAI Lei;YANG Yongbin;JI Lin;WANG Haiqian;LIU jianglong;LI Xiaodong(Department of Cardiovascular Surgery,General Hospital of Ningxia Medical University,Yinchuan,the Ningxia Hui Autonomous Region 750004,China)

机构地区：[1]宁夏医科大学总医院心脏大血管外科,银川750004 [2]宁夏医科大学总医院心脑血管病医院门诊部,银川750004 [3]甘肃省人民医院血管外科 [4]新疆巴音郭楞蒙古自治州人民医院介入科

出　　处：《介入放射学杂志》2021年第12期1219-1223,共5页Journal of Interventional Radiology

基　　金：宁夏回族自治区重点研发计划项目(2018BEG03029);宁夏回族自治区自然科学基金(2020AAC03367)。

摘　　要：目的总结采用主动脉支架预开窗联合分支支架技术治疗伴有迷走锁骨下动脉(ASA)的Stanford B型主动脉夹层(TBAD)患者的经验。方法2017年至2019年宁夏医科大学总医院在TBAD患者术前主动脉CTA检查中发现4例伴发ASA。4例患者均为男性,中位年龄47.3岁(44~52岁),均接受择期胸主动脉腔内支架预开窗联合分支支架修复术治疗,随访观察腔内修复术可行性和临床疗效。结果4例患者择期手术均获成功,未发生围手术期死亡、严重脑卒中或脊髓缺血并发症。随访12~36个月,无患者死亡,无上肢缺血、后循环缺血、脊髓缺血等情况出现。所有患者的锁骨下动脉(SA)和ASA通畅,无分支支架狭窄/闭塞。结论采用体外支架双开窗技术腔内修复治疗TBAD伴ASA可行,近中期效果满意,远期效果仍需随访;建议同时重建双侧SA,以保留上肢动脉血供,更重要的是保留脊髓和椎基底动脉血供。Objective To summarize the clinical experience of using aortic stent pre-fenestration technology in treating Stanford type B aortic dissection(TBAD)associated with aberrant subclavian artery.Methods Between 2017 and 2019,a total of 4 patients with TBAD complicated by aberrant subclavian artery,which was confirmed by preoperative CT angiography examination,were encountered at the General Hospital of Ningxia Medical University of China.All the 4 patients were male with a median age of 47.3 years(44-52 years).Elective thoracic endovascular aortic repair(TEVAR)with aortic stent pre-fenestration technology combined with subclavian stenting repair was adopted in all the 4 patients.The patients were followed up,and the feasibility and clinical efficacy of TEVAR were evaluated.Results Successful TEVAR was accomplished in all the 4 patients.No perioperative death,severe stroke,or spinal cord ischemia occurred.During the follow-up period of 12-36 months,no death or major complications such as upper limb ischemia,posterior circulation ischemia and spinal cord ischemia occurred.Both the subclavian artery and aberrant subclavian artery remained unobstructed,and no stenosis or occlusion of branch stent was observed.Conclusion The limited experience obtained in this study indicates that it is clinically feasible to use extracorporeal aortic stent double pre-fenestration technology in performing endovascular treatment for TBAD complicated by aberrant subclavian artery.The short-to-mid-term effect of this therapy is satisfactory,although the long-term effect needs to be verified.In order to maintain the upper limb arterial blood supply,more importantly to maintain the spinal and vertebral basal arterial blood supply,simultaneous reconstruction of bilateral subclavian arteries is recommended.

关 键 词：主动脉夹层 迷走锁骨下动脉 胸主动脉腔内修复 预开窗 

分 类 号：R543.1[医药卫生—心血管疾病]