行改进术式预防逆行性A型夹层的效果研究  

Ascending aorta aortoplasty + debranch+ thoracic endovascular aortic repair: a new attempt to prevent retrograde type a dissection

作　　者：高慧强[1] 刘愚勇[1] 许尚栋[1] GAO Huiqiang;LIU Yuyong;XU Shangdong(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2022年第1期61-64,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:逆行性A型夹层是升主动脉-头臂血管人工血管转流术+胸降主动脉覆膜支架置入术(d-TEVAR)术后一种高发而致命的并发症,导致d-TEVAR仅在高危弓部病变患者中使用。自体升主动脉与覆膜支架间的顺应性不匹配是导致d-TEVAR术后逆行性A型夹层发生的重要原因之一。本文介绍一种新的方法以求减少逆行性A型夹层的发生。方法:我们采用新的手术方式:升主动脉成形+Debranch-TEVAR,通过用人工血管包裹升主动脉,增强其强度并限制其运动,降低与覆膜支架间的顺应性不匹配,进而降低逆行性A型夹层发生的可能性。结果:手术过程完全成功且可行,4例手术患者围术期及短期随访期间无逆行性A型夹层产生。结论:这种改进术式能在一定程度上避免逆行性A型夹层的产生,能将d-TEVAR的手术适应证扩展至低危患者。Objective: Retrograde type a dissection is a high-incidence and fatal complication after debranch+ thoracic endovascular aortic repair(d-TEVAR), which makes d-TEVAR only used in patients with high-risk arch diseases. The compliance mismatch between the ascending aorta and the stent graft is one of the important reasons for retrograde type A dissection after d-TEVAR. This article introduces a new method to reduce the occurrence of retrograde type A dissection. Methods: Here is a new and improved surgical procedure: ascending aorta angioplasty + Debranch-TEVAR. By wrapping the ascending aorta with an artificial blood vessel, it enhances its strength and restricts its movement, reducing the compliance mismatch with the stent graft, thereby reducing the possibility of retrograde type A dissection. Results: The surgical procedure was completely successful and feasible. There were no retrograde type A dissections in the perioperative period and short-term follow-up period of the four surgical patients. Conclusions: Perhaps this improvement can extend the surgical indications of d-TEVAR to low-risk patients.

关 键 词：升主动脉成形 胸降主动脉覆膜支架置入术 去分支 主动脉弓 

分 类 号：R54[医药卫生—心血管疾病]