| 陈浩 刘伟 王宏宇 姜明泽 石晨 刘茂林 曹建军△.复杂型Stanford B型主动脉夹层腔内修复术中左锁骨下动脉重建方式分析[J].,2017,17(2):323-326 |
| 复杂型Stanford B型主动脉夹层腔内修复术中左锁骨下动脉重建方式分析 |
| Analysis the Mode of Reconstruct Left Clavicle Artery of EndovascularAortic Repair for Complicated Stanford B Type Aortic Dissection |
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| DOI： |
| 中文关键词: 血管旁路 开窗技术 烟囱技术 腔内修复术 Stanford B型夹层 |
| 英文关键词: Bypass In situ laser fenestration "Chimney" stenting technology Endovascular repair Stanford B type aortic dissection |
| 基金项目:湖北省教育厅指导项目（B2016137）；十堰市科技局引导性项目（16Y67，15Y49） |
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| 中文摘要: |
| 目的：总结复杂型Stanford B型主动脉夹层中左锁骨下动脉重建的经验和方法。方法：2010 年4 月至2016 年5 月，共有43
例复杂型Stanford B型主动脉夹层采用腔内修复术治疗，并均重建左锁骨下动脉，其中右腋动脉- 左腋动脉人工血管旁路18 例，
开窗技术14 例，烟囱技术11 例。结果：均成功手术，无术中死亡，术后造影显示支架敷贴良好，定位准确，左锁骨下动脉血流通
畅。术后无头晕症状，双上肢血压差均在15 mmHg之内。1 例术后5 天并发逆行性A 型夹层猝死。肾功能衰竭2 例，行透析治疗
后治愈。随访38 例，失访4 例，随访时间2～33月(17.0 士5.2月)，1 例患者术后45 天猝死；术后3 月、1 年复查主动脉CTA 均示
支架无移位。1 例I型内漏，术后8 月复查CTA 示内漏消失；1 例术后9 月人工血管内血栓形成，中段狭窄约40%；2 例并发支架
远端动脉瘤形成。结论：腋动脉人工血管旁路术、开窗技术、烟囱技术进行左锁骨下动脉重建，联合主动脉腔内修复术治疗复杂型
Standford B型主动脉夹层，可以取得满意的临床效果。 |
| 英文摘要: |
| Objective:To summarize our experience and methods of analysis the mode of reconstruct left clavicle artery of
endovascular aortic repair for complicated Stanford B type aortic dissection.Methods:The clinical data of 43 patients with complicated
Stanford B type aortic dissection underwent endovascular aortic repair and all of cases reconstructed left clavicle artery. The methods of
reconstructed left clavicle artery for the patients including 18 cases received right axillary -left axillary PTFE graft bypass, 14 cases
received in situ laser fenestration, and 11cases underwent "Chimney" stenting technology.Results:All the 43 patients were successfully
operated, whose stents were successfully released, and the left clavicle which had blood flow patency. All stents received the treatment
without suffering dizzy spells, and their blood pressure difference within 15 mmHg between the upper extremities. One case suffered
sudden death after 5 days because of retrogression of type A aortic dissection. Two cases had renal failure who were cured by
hemodialysis. Thirty-eight cases were followed up at 3 months to 33 months. One case suffered sudden death after 45 days. After 1 years,
the patients received aortic CTA, which were showed all of the intravascular stent without shift. One patient with typeⅠ endoleak was
restored within 8 months, which was showed by aortic CTA. One case with artery stenosis in the the middle of artificial blood vessel after
9 months, which within 40%. Two patients occurred aneurysms at the distal end of the stent.Conclusion:The method of reconstructed
left clavicle artery (Axillary - axillary bypass grafting, in situ laser fenestration and "Chimney" stenting techology) which associate with
endovascular repair treatment is a satisfactory way for complicated StanfordB type aortic dissection. |
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