鹅颈式抓捕器在主动脉腔内手术中的巧用体会:附11例病例报道  

Experience in the use of GooseNeck Snare Kit in endovascular aortic surgery:a report of 11 cases

作　　者：方昌文 张志轩[1] 徐国雄[1] 金一琦[1] 张俊[1] 李文东 陈弘 王亚丹 Fang Changwen;Zhang Zhixuan;Xu Guoxiong;Jin Yiqi;Zhang Jun;Li Wendong;Chen Hong;Wang Yadan(Center of Cardiovascular Diseases,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou215000,China;Department of Vascular Surgery,The Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing210008,China)

机构地区：[1]南京医科大学附属苏州医院心血管病中心,苏州215000 [2]南京大学医学院附属鼓楼医院血管外科,南京210008

出　　处：《中华血管外科杂志》2024年第6期392-397,共6页Chinese Journal of Vascular Surgery

基　　金：苏州市卫生健康委员会临床重点病种项目(LCZX202314)。

摘　　要：目的探讨鹅颈式抓捕器在不同类型主动脉腔内手术中的辅助应用价值。方法本研究为回顾性病例系列研究。回顾分析2022年10月至2024年3月南京医科大学附属苏州医院心血管病中心和南京大学医学院附属鼓楼医院血管外科收治的11例采用鹅颈式抓捕器辅助主动脉腔内手术患者的临床资料,其中男性7例,女性4例;年龄(67.3±6.8)岁;包括腹主动脉瘤合并髂动脉瘤8例,主动脉瓣狭窄2例,胸腹主动脉瘤1例。分别采用鹅颈式抓捕器辅助实施髂动脉分支支架(IBD)植入术、主动脉瓣膜植入术及医师改良四分支覆膜支架植入术。观察和评估手术效果并总结鹅颈式抓捕器辅助应用于腔内手术的经验。结果手术成功率100%。在抓捕器的辅助下,8例接受IBD手术的患者采用改良双侧股动脉入路,建立体外牵张顺利完成;2例经导管主动脉瓣膜植入术成功解决瓣膜输送系统无法跨主动脉瓣的困难;1例医师改良四分支覆膜支架手术中顺利解决无法选入肾动脉的困难。11例患者术后7 d无死亡,无心力衰竭、截瘫、肾功能衰竭等并发症发生。结论鹅颈式抓捕器在IBD植入、瓣膜(或支架)输送系统跨主动脉瓣及胸腹主动脉开窗选择内脏动脉中有较好的辅助作用。ObjectiveTo evaluate the application of the GooseNeck Snare Kit in different conditions of endovascular aortic surgery.MethodsIn this retrospective case series analysis,clinical data of 11 patients undergoing GooseNeck Snare Kit-assisted endovascular aortic surgery in the Center of Cardiovascular Diseases of the Affiliated Suzhou Hospital of Nanjing Medical University and the Department of Vascular Surgery of the Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School between October 2022 and March 2024 were reviewed.The cohort included 7 males and 4 females,with an age of(67.3±6.8)years.The diagnoses included abdominal aortic aneurysm combined with iliac artery aneurysm(8 cases),aortic stenosis,(2 cases)and thoracoabdominal aortic aneurysm(1 case).The goose neck snare was employed to assist in iliac branch device(IBD)implantation,aortic valve implantation,and physician-modified four-fenestrated endograft respectively assisted by the Snare Kit.The surgical outcomes were evaluated,and the experience of using the goose neck snare in endovascular surgeries was summarized.ResultsThe success rate of the surgery was 100%(11/11).With the assistance of the Snare Kit,8 patients underwent IBD surgery with the improved bilateral femoral artery approach,and the establishment of external stretch was completed.It also overcame the difficulty of the valve delivery system to cross the aortic valve in 2 patients undergoing transcatheter aortic valve implantation,and the difficulty of the selective entry into the renal artery during physician-modified four-fenestrated endograft operation in 1 patient.There were no deaths in 11 patients 7 days after surgery,and no complications such as heart failure,paraplegia,or renal failure occurred.ConclusionThe GooseNeck Snare Kit provides effective assistance in the IBD implantation,the valve(or stent)delivery system to cross the aortic valve,and the selection of visceral arteries in thoracoabdominal aortic fenestration.

关 键 词：抓捕器 髂动脉瘤 主动脉瓣置换 腹主动脉瘤 开窗支架 

分 类 号：R54[医药卫生—心血管疾病]