体外开窗技术治疗主动脉弓部病变的中期效果  

Midterm outcomes of surgeon⁃modified fenestrated stent⁃graft for aortic arch pathologies

作　　者：李钢 徐心阳 刘鸿 李明辉 顾嘉玺 倪布清 LI Gang;XU Xinyang;LIU Hong;LI Minghui;GU Jiaxi;NI Buqing(Department of Cardiac Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心脏大血管外科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2024年第7期966-971,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：南京医科大学专病联盟公益项目(NMU2023SD101)。

摘　　要：目的:探究胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)联合左锁骨下动脉(left subclavian artery,LSA)体外开窗技术治疗主动脉弓部病变的中期效果。方法:选择2018年1月—2021年12月南京医科大学第一附属医院收治的111例行TEVAR联合LSA体外开窗技术治疗的患者,回顾性分析其围术期以及中期随访的临床材料。结果:手术成功率为100%(111/111),30 d内病死率为3.6%(4/111),术后中位随访时间为33.0个月,全因病死率为6.3%(7/111),主动脉相关的病死率为2.7%(3/111),主要并发症中脑血管意外3例(2.7%),截瘫2例(1.8%),近端逆撕形成A型主动脉夹层1例(0.9%),支架内漏2例(1.8%),支架移植物引起远端新发破口3例(2.7%)。进行主动脉二次干预的有4例(3.6%),其中3例(2.7%)腔内手术,1例(0.9%)开胸行人工血管置换手术。结论:TEVAR联合LSA体外开窗技术治疗主动脉弓部病变的中期效果在可接受的范围内,但是仍缺乏长期的观察结果数据。此外,开窗技术流程亟待规范统一,相关设备也待进一步开发。Objective:To investigate the midterm outcomes of thoracic endovascular aortic repair(TEVAR)combined with left subclavian artery(LSA)fenestration for aortic arch diseases.Methods:We retrospectively analyzed the perioperative period and midterm follow-up clinical data of 111 patients who underwent TEVAR combined with LSA fenestration in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2021.Results:Overall,the success rate of the surgery was 100%(111/111),the mortality rate within 30 days was 3.6%(4/111).The median postoperative follow-up time was 33.0 months,the all-cause mortality was 6.3%(7/111),the aorta-related mortality was 2.7%(3/111).Among the main complications,there were 3 patients(2.7%)of cerebrovascular accident,2 patients(1.8%)of paraplegia,1 patient(0.9%)of retrograde type A dissection(RTAD),2 patients(1.8%)of endoleak,and 3 patients(2.7%)of distal stent-induced new entry(dSINE).Four patients(3.6%)underwent the second aortic intervention,of which 3 patients(2.7%)were performed endovascular surgery and 1 patient(0.9%)was performed thoracotomy and artificial vascular replacement.Conclusion:The mid-term outcomes of TEVAR combined with LSA fenestration for aortic arch diseases were within the acceptable range,however,further follow-up results are needed and long-term stability and durability needs to be assessed.In addition,the technical process of fenestration needs to be standardized and unified,and related equipment needs to be further developed.

关 键 词：主动脉夹层 主动脉腔内修复术 体外开窗技术 左锁骨下动脉 支架内移植物 

分 类 号：R654.3[医药卫生—外科学]