激光原位开窗胸主动脉腔内重建治疗累及弓部分支的主动脉夹层:近期结果及并发症

doi:10.16139/j.1007-9610.2022.04.010

摘要/Abstract

摘要：

目的：评价激光原位开窗腔内重建治疗累及弓部分支主动脉夹层的手术效果及其并发症。方法：回顾性分析2018年12月至2020 年12月,我院血管外科收治累及弓部主动脉夹层病人181例,172例接受激光原位开窗腔内修复技术治疗。纳入标准为夹层累及主动脉弓部,腔内技术修复主动脉夹层过程需重建弓部分支血管。主动脉夹层病变范围距离冠状动脉开口<15 mm,升主动脉直径>45 mm的病人排除。结果：172例病人行激光原位开窗及主动脉腔内修复术,其中37例(21.51%)在急性期,135例(78.49%)在亚急性期。重建弓部分支血管技术成功率95.93%(165/172)。院内死亡6例(3.49%),卒中2例(1.16%),截瘫4例(2.33%),近端支架源性夹层2例(1.16%),无远端支架源性夹层。随访168例(97.67%)。共重建311个弓上分支血管。CT血管造影随访(10.6±5.4)个月,显示弓上分支血管通畅295个,通畅率94.86%。172例中152例(88.37%)表现为胸主动脉段部分或全部假腔血栓形成。结论：应用激光原位开窗技术治疗累及主动脉弓部分支夹层成功率高,并发症发生率低。远期临床效果尚需长期随访和大样本研究的验证。

关键词: 主动脉夹层, 腔内修复, 分支重建, 激光原位开窗, 并发症

Abstract:

Objective To evaluate the surgical effect and complication of laser in situ fenestration with thoracic endovascular aortic repair (TEVAR) in the patients with aortic dissection involving arch branches. Methods From December 2018 to December 2020, 181 patients with aortic dissection involving arch branches admitted to our hospital were analyzed retrospectively among whom 172 patients had laser in situ fenestration with TEVAR. The inclusion criteria were dissection involved aortic arch and the process of TEVAR required reconstruction of the branched vessels in arch. Patients both with aortic dissection lesions less than 15 mm from the coronary ostium and the diameter of ascending aorta more than 45 mm were excluded. Results All cases underwent laser in situ fenestration with TEVAR including 37 cases (21.51%) in acute stage and 135 cases (78.49%) in subacute stage and 165 cases (95.93%) with success of reconstruction of branch vessels. In-hospital death occurred in 6 cases (3.49%), stroke in 2 cases (1.16%), paraplegia in 4 cases (2.33%), proximal stent-graft induced new entry (SINE) in 2 cases (1.16%), and without distal SINE. A total of 168 cases (97.67%) were followed-up. There were 311 branch vessels reconstructed. Follow-up CT angiography was done(10.6±5.4) months which showed that 295 branch vessels were patency with patency rate 94.86%. The partial or complete false lumen thrombosis of thoracic aorta was found in 152 cases (88.37%). Conclusions Laser in situ fenestration with TEVAR was performed with high success rate and low complication rate for the patients with aortic dissection involving arch branches. Long-term follow-up and large sample studies are needed for long-term clinical effects.

Key words: Aortic dissection, Endovascular repair, Reconstruction of branched vessel, Laser in situ fenestration, Complication

中图分类号:

R543.1

王瑞华, 仇鹏, 刘俊超, 吴小雨, 秦金保, 叶开创, 李维敏, 刘晓兵, 殷敏毅, 黄新天, 陆信武. 激光原位开窗胸主动脉腔内重建治疗累及弓部分支的主动脉夹层:近期结果及并发症[J]. 外科理论与实践, 2022, 27(04): 324-329.

WANG Ruihua, QIU Peng, LIU Junchao, WU Xiaoyu, QIN Jinbao, YE Kaichuang, LI Weimin, LIU Xiaobing, YIN Minyi, HUANG Xintian, LU Xinwu. Laser in situ fenestration with thoracic endovascular aortic repair in treatment of aortic dissection involving arch branches: short-term result and complications[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 324-329.

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