摘要
目的探讨"烟囱"技术在主动脉夹层腔内隔绝术中保留重要分支动脉的作用及疗效。方法对2009年6月—2010年2月收治的8名第一破口位于主动脉弓部重要分支附近、腔内修复治疗近端锚定区不足的主动脉夹层患者的临床资料进行回顾分析。在DSA下对夹层第一破口及左颈总动脉、左锁骨下动脉开口行腔内隔绝的同时,以"烟囱"支架重建左颈总动脉的血流。术后2周行螺旋CT检查,观察疗效以及有无内漏、支架移位等并发症。结果手术成功率100%,无I型内漏发生,2例发生左锁骨下动脉延迟性返血。术后随访2～10个月,主动脉内支架型人工血管位置良好,左颈动脉内"烟囱"支架保持通畅,无移植物相关的漏血发生。2例左锁骨下动脉延迟性返血的患者中,1例于术后2周消失,1例随访5个月持续存在,但为微量且有减少趋势。结论 "烟囱"技术可以为第一破口位于弓部重要分支动脉附近的动脉夹层患者,提供腔内隔绝术治疗机会,避免主动脉弓部血管重建开放手术带来的大的创伤。短期随访结果满意,远期疗效有待于进一步随访。
Objective To assess the use and outcomes of chimney grafts inserting into the left carotid artery in endovascular repair of aortic dissection.Methods The clinical data of 8 patients with aortic dissection [7 male, 1 female with average age （47.25±15.35） （29-71） years] hospitalised in our hospital from June 2009 to February 2010 were analysed retrospectively. They all suffered from aortic dissection that did not have adequate proximal zone for sealing the stent the stent. These patients were managed by endovascular repair combined with placement of chimney grafts to restore flow of the aortic branches which were intentionally covered. Follow-up examinations was made by spiral computer tomography. Results All the 8 operations were clinically successful after treatment, and no patient died in the perioperative period. Type II endoleaks occurred in 2 patients, but one disappeared in 2 weeks, while one persisted but decreased in size at 5 months postoperatively. During the follow-up of 2-10 months postoperatively, spiral CT showed patency of all stent-grafts, enlargement of true lumen and compression of false lumen. No other complications occurred. Conclusions Endovascular repair combined with protecting aortic branches by chimney grafts for aortic dissection with inadequate proximal sealing zones seems promising at short-term follow-up. More cases and data are needed to evaluate the safety and efficiency of this technique.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2010年第12期1266-1270,共5页
China Journal of General Surgery
关键词
动脉瘤
夹层
主动脉
腔内修复术
烟囱技术
Aneurysm
Dissecting
Aortic
Chimney Graft
Endovascular Repair
