Castor单分支支架腔内治疗Stanford B型主动脉夹层单中心回顾性研究  

Endovascular treatment of type B aortic dissection with the Castor single-branched stent:a single-center retrospective study

作　　者：方敏 张昊 张雷 魏小龙 袁良喜 宋超 赵志青 包俊敏 刘广钦 陆清声 FANG Min;ZHANG Hao;ZHANG Lei;WEI Xiaolong;YUAN Liangxi;SONG Chao;ZHAO Zhiqing;BAO Junmin;LIU Guangqin;LU Qingsheng(Department of General Surgery,the First Affiliated Hospital(Changhai Hospital)of Naval Medical University,Shanghai 200433,China;Department of Vascular Surgery,the First Affiliated Hospital(Changhai Hospital)of Naval Medical University,Shanghai 200433,China)

机构地区：[1]中国人民解放军海军军医大学附属第一医院(长海医院)普通外科,上海200433 [2]中国人民解放军海军军医大学附属第一医院(长海医院)血管外科,上海200433

出　　处：《中国普通外科杂志》2024年第6期901-908,共8页China Journal of General Surgery

基　　金：国家自然科学资助基金面上项目(82270510)。

摘　　要：背景与目的:随着腔内治疗的发展,累及左锁骨下动脉(LSA)的Stanford B型主动脉夹层的治疗方案逐渐成熟,但由于该部位解剖结构复杂、器具自身局限,仍旧存在内漏、锚定区损伤、逆撕等并发症。本研究通过单中心回顾性研究探讨Castor单分支支架治疗Stanford B型主动脉夹层的效果。方法:纳入中国人民解放军海军军医大学附属第一医院血管外科自2018年12月─2021年10月期间使用Castor单分支支架进行腔内手术的Stanford B型主动脉夹层患者。收集入组患者的术前Dicom格式全主动脉计算机体层成像血管造影(CTA)影像、术中详细信息及随访预后结果,使用EndoSize软件测量夹层近远端锚定区动脉直径、病变长度、LSA开口与夹层关系等指标,并结合术中使用移植物情况计算支架放大率,观察并记录手术成功率、近远期并发症率等指标。结果:共纳入107例Stanford B型主动脉夹层患者,全部采用腔内手术方式,手术均取得技术成功。夹层近端主要裂口与LSA距离(42.7±17.3)mm;夹层近端边缘与LSA距离(7.7±13.2)mm;主动脉近端锚定区直径(31.5±3.0)mm;左颈总动脉开口远端与LSA开口近端距离(8.5±2.6)mm。Castor主体支架近端直径(32.5±3.3)mm,远端直径(26.6±3.3)mm,分支支架直径(10.7±3.5)mm。主体支架近端放大率为(3.2±3.5)%,远端放大率为(0.1±9.5)%。围手术期与随访期间,共9例患者死亡,其中1例术前严重低血压,术后1 d死于低灌注引起的多脏器功能衰竭;1例患者于术后4 d死于夹层逆撕破裂;1例患者于术后1个月死于呼吸衰竭;1例患者于术后4个月死于肺部感染;2例患者于术后6个月死于心衰;2例患者分别于术后9个月及14个月死于脑出血;1例患者于术后11个月死于不明原因疾病。6例患者出现主动脉夹层相关不良事件,其中围手术期出现1例夹层逆撕,3例脑梗,随访期间出现1例Ib型内漏,1例分支支架闭塞。结论:Stanford B型�Background and Aims:With the advancement of endovascular therapy,the treatment strategies for Stanford type B aortic dissection involving the left subclavian artery(LSA)have gradually matured.However,due to the complex anatomical structure of this area and the limitations of the devices themselves,complications such as endoleak,landing zone injury,and retrograde dissection still exist.This study explores the effectiveness of the Castor single-branched stent in treating Stanford type B aortic dissection through a single-center retrospective study.Methods:Patients with Stanford type B aortic dissection who underwent endovascular surgery using the Castor single-branched stent in the Department of Vascular Surgery of the First Affiliated Hospital of Naval Medical University from December 2018 to October 2021 were included.Preoperative Dicom format full aortic CTA images,detailed intraoperative information,and follow-up outcomes of the included patients were collected.EndoSize software was used to measure variables such as the arterial diameter of the proximal and distal landing zones of the dissection,the length of the lesion,and the relationship between the LSA opening and the dissection.The stent enlargement rate was calculated based on the grafts used during surgery.The success rate of the surgery and the incidence rates of shortand long-term complications were observed and recorded.Results:A total of 107 cases of Stanford type B aortic dissection were included,all of which were treated with endovascular surgery,achieving technical success in all cases.The distance from the main tear in the proximal dissection to the LSA was(42.7±17.3)mm;the distance from the proximal edge of the dissection to the LSA was(7.7±13.2)mm;the diameter of the proximal landing zone of the aorta was(31.5±3.0)mm;and the distance from the distal opening of the left common carotid artery to the proximal opening of the LSA was(8.5±2.6)mm.The proximal diameter of the main body of the Castor stent was(32.5±3.3)mm,the distal diameter was(26

关 键 词：动脉瘤 夹层 主动脉 胸 血管内操作 支架 

分 类 号：R654.3[医药卫生—外科学]