[1]张 涛,纪东华,王 峰.胸主动脉腔内修复术联合体外开窗技术治疗累及主动脉弓的复杂胸主动脉疾病[J].介入放射学杂志,2021,30(09):882-887.
 ZHANG Tao,JI Donghua,WANG Feng..Thoracic endovascular aortic repair combined with extracorporeal fenestration technique for the treatment of complex thoracic aortic diseases involving aortic arch[J].journal interventional radiology,2021,30(09):882-887.
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胸主动脉腔内修复术联合体外开窗技术治疗累及主动脉弓的复杂胸主动脉疾病()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
30
期数:
2021年09
页码:
882-887
栏目:
血管介入
出版日期:
2021-09-25

文章信息/Info

Title:
Thoracic endovascular aortic repair combined with extracorporeal fenestration technique for the treatment of complex thoracic aortic diseases involving aortic arch
作者:
张 涛 纪东华 王 峰
Author(s):
ZHANG Tao JI Donghua WANG Feng.
Department of Interventional Therapy, Affiliated First Hospital of Dalian Medical University, Dalian, Liaoning Province 116011, China
关键词:
【关键词】 胸主动脉腔内修复术 主动脉弓 开窗支架 主动脉夹层
文献标志码:
A
摘要:
【摘要】 目的 报道胸主动脉腔内修复术(TEVAR)联合体外开窗技术治疗累及主动脉弓的复杂主动脉疾病的初步经验,并探讨其可行性、安全性和有效性。 方法 回顾性分析2017年2月至2019年11月大连医科大学附属第一医院在TEVAR术中采用体外开窗技术治疗的15例累及主动脉弓的复杂胸主动脉疾病患者临床资料。分析技术成功率、围术期死亡率和术后随访等。 结果 15例患者中,主体开窗支架近端植于主动脉Z0、Z1、Z2区各5例。移植物单开窗9例,双开窗4例,三开窗2例。总计重建26条分支血管,其中无名动脉3条、左颈总动脉8条、左锁骨下动脉11条、迷走右锁骨下动脉2条以及无名动脉、左颈总动脉共干各1条;人工遮盖左锁骨下动脉4条。术后所有重建分支血管即刻造影显示血流通畅,技术成功率100%。围术期死亡2例(13.3%),无缺血性脑卒中、截瘫等严重并发症发生。随访期失访2例(3条分支血管)。1例1条左锁骨下动脉狭窄,2例(13.3%)见少许内漏,均逐渐减少,2例死亡。 结论 TEVAR体外开窗技术治疗累及主动脉弓的复杂主动脉疾病可行、安全有效,近期效果满意。

参考文献/References:

[1] Dake MD,Miller DC,Semba CP,et al. Transluminal placement of endovascular stent- grafts for the treatment of descending thoracic aortic aneurysms[J]. N Engl J Med, 1994, 331:1729- 1734
[2] Xenos ES, Minion DJ, Davenport DL, et al. Endovascular versus open repair for descending thoracic aortic rupture: institutional experience and meta- analysis[J]. Eur J Cardiothorac Surg, 2009, 35:282- 286.
[3] Chiu P, Goldstone AB, Schaffer JM, et al. Endovascular versus open repair of intact descending thoracic aortic aneurysms[J]. J Am Coll Cardiol ,2019,73:643- 651
[4] Faruqi RM,Chuter TA,Reilly LM,et al. Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent- graft[J]. J Endovasc Surg, 1999, 6: 354- 358.
[5] Browne TF, Hartley D, Purchas S, et al. A fenestrated covered suprarenal aortic stent[J]. Eur J Vasc Endovasc Surg, 1999,18:445- 449.
[6] Rudarakanchana N,Jenkins MP. Hybrid and total endovascular repair of the aortic arch[J]. Br J Surg, 2018, 105:315- 327.
[7] Huang C, Liu Z, Huang D,et al. Application of unibody single- branch endografts in Stanford type B dissections with primary entry tear adjacent to the left subclavian artery: a computed tomography- based planning study[J]. Ann Vasc Surg, 2015, 29:1174- 1180.
[8] Kuo HS, Huang JH, Chen JS. Handmade fenestrated stent grafts to preserve all supra- aortic branches in thoracic endovascular aortic repair[J]. J Thorac Cardiovasc Surg, 2020, 160:629.e1- 639.e1.
[9] Zhang L, Wu MT, Zhu GL, et al. Off- the- shelf devices for treatment of thoracic aortic diseases: midterm follow- up of TEVAR with chimneys or physician-made fenestrations[J]. J Endovasc Ther, 2020, 27: 132- 142.
[10] 朱杰昌,戴向晨,罗宇东,等. 体外开窗腔内主动脉修复术治疗胸腹主动脉病变的早期结果分析[J]. 中华医学杂志, 2018, 98:921- 925.
[11] Lu Q,Jing Z,Zhao Z,et al. Endovascular stent graft repair of aortic dissection type B extending to the aortic arch[J]. Eur J Vasc Endovasc Surg, 2011, 42:456- 463.
[12] Appoo JJ, Tse LW, Pozeg ZI, et al. Thoracic aortic frontier: review of current applications and directions of thoracic endovascular aortic repair(TEVAR)[J]. Can J Cardiol, 2014, 30:52- 63.
[13] Moulakakis KG, Mylonas SN, Dalainas I, et al. The chimney- graft technique for preserving supra- aortic branches: a review[J]. Ann Cardiothorac Surg, 2013, 2:339- 346.
[14] 陆清声. 主动脉弓疾病腔内治疗体外开窗技巧[J]. 中国血管外科杂志(电子版), 2019, 11:83- 85.
[15] Buth J, Harris PL, Hobo R,et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair(EUROSTAR) registry[J]. J Vasc Surg, 2007, 46:1103- 1110.
[16] Cooper DG, Walsh SR, Sadat U, et al. Neurological complications after left subclavian artery coverage during thoracic endovascular aortic repair: a systematic review and meta- analysis[J]. J Vasc Surg, 2009, 49:1594- 1601.
[17] Roselli EE, Idrees JJ, Johnston DR, et al. Zone zero thoracic endovascular aortic repair: a proposed modification to the classi-fication of landing zones[J]. J Thorac Cardiovasc Surg, 2018, 155:1381- 1389.

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备注/Memo

备注/Memo:
(收稿日期:2020- 05- 13)
(本文编辑:边 佶)
更新日期/Last Update: 2021-09-13