原位开窗与体外预开窗技术重建左锁骨下动脉治疗不良近端锚定区主动脉弓部病变的疗效分析  

Efficacy of in situ fenestration versus in vitro pre-fenestration for reconstruction of left subclavian artery in the treatment of aortic arch lesions with unfavorable proximal landing zone

作　　者：周保宁 化召辉[1] 张帅[1] 马珂[1] 李震[1] ZHOU Baoning;HUA Zhaohui;ZHANG Shuai;MA Ke;LI Zhen(Department of Endovascular Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院腔内血管外科,河南郑州450052

出　　处：《中国普通外科杂志》2023年第12期1892-1900,共9页China Journal of General Surgery

基　　金：河南省高等学校重点科研基金资助项目(22A320081)。

摘　　要：背景与目的:目前,开窗技术已被广泛应用于各种胸主动脉疾病的治疗。开窗技术可分为原位开窗与体外预开窗,两者具有各自的特点和优缺点。本研究对比分析原位开窗与体外预开窗技术用于不良(短或不健康)近端锚定区主动脉弓病变左锁骨下动脉(LSA)重建的早期及中期疗效,并总结开窗方式的选择经验。方法:回顾性分析2019年3月—2022年3月郑州大学第一附属医院利用原位开窗或体外预开窗技术重建LSA治疗的215例主动脉弓部病变患者的临床资料。其中114例采用原位开窗(原位开窗组),101例采用体外预开窗(体外预开窗组),对比分析两组间技术成功率、围手术期及随访期不良事件发生情况及病死率等。结果:原位开窗组技术成功率为93.9%(开窗失败3例、Ia型内漏3例、入路血管损伤1例);1例术后4 d发生双侧多发急性脑梗死,经保守治疗后患者恢复良好;30 d内主动脉相关死亡3例,2例分别于术后10 d和25 d死于夹层累及内脏动脉导致的多器官功能衰竭,1例术后2 d死于腹主动脉夹层破裂。体外预开窗组技术成功率为94.1%(1例因支架移位LSA被覆盖、Ⅲ型内漏3例、Ⅰa型内漏2例);1例术后1 d发生右侧急性脑梗死,经内科治疗后患者恢复良好;无主动脉相关死亡。中位随访时间为原位开窗组26(10~46)个月、体外预开窗组19(10~44)个月。随访期间原位开窗组术后6个月发生分支支架闭塞1例、术后3个月Ⅰa型内漏2例;体外预开窗组术后3个月近端夹层动脉瘤形成1例、术后3个月Ⅰa型内漏2例,两组均未发生主动脉相关死亡。两组技术成功率、围术期及随访期不良事件发生率和病死率差异均无统计学意义(均P>0.05)。结论:原位开窗与体外预开窗技术重建LSA治疗主动脉弓部病变均具有良好的安全性与有效性,根据患者解剖条件及疾病情况进行个体化术式选择可提高技术成功率并减少并发症的�Background and Aims:Currently,the fenestration technique has been widely applied in the treatment of various thoracic aortic diseases.Fenestration techniques can be categorized into in situ fenestration and in vitro pre-fenestration,each with its own characteristics,advantages and disadvantages.This study was conducted to compare and analyze the short-and mid-term efficacy of in situ fenestration and in vitro pre-fenestration techniques in the reconstruction of left subclavian artery(LSA)for aortic arch lesions with unfavorable proximal landing zone(either short or unhealthy),and also summarize the experience in selecting fenestration approaches.Methods:The clinical data of 215 patients with aortic arch diseases treated with LSA reconstruction using in situ fenestration or in vitro pre-fenestration technique in the First Affiliated Hospital of Zhengzhou University from March 2019 to March 2022 were retrospectively analyzed.Among them,114 cases underwent in situ fenestration(in situ fenestration group),and 101 cases were treated with in vitro pre-fenestration(in vitro pre-fenestration group).The technical success rates,perioperative and follow-up adverse events,and mortality rates were compared between the two groups.Results:The technical success rate in the in situ fenestration group was 93.9%(3 cases of fenestration failure,3 cases of type Ia endoleak,and 1 case of access vessel injury);one patient developed bilateral multiple acute cerebral infarctions 4 d after operation,and the patient recovered well with conservative treatment;there were 3 aorta-related deaths within 30 d,with 2 deaths occurring on postoperative day 10 and day 25 due to visceral artery involvement causing multi-organ failure,and 1 death on postoperative day 2 due to rupture of the abdominal aorta dissection.The technical success rate in the in vitro prefenestration group was 94.1%(1 case of LSA coverage due to stent displacement,3 cases of typeⅢendoleak,2 cases of type Ia endoleak);one patient experienced right-sided acute cerebral infarct

关 键 词：主动脉疾病 血管内操作 锁骨下动脉 开窗术 

分 类 号：R654.3[医药卫生—外科学]