腔内修复治疗主动脉弓降部病变33例

目的总结应用血管腔内修复术治疗主动脉弓降部病变的初步经验。方法 2007年7月至2011年9月福建医科大学附属协和医院心血管外科对33例主动脉弓降部病变患者实施血管腔内修复术(endovascular aneurysm repair,EVAR)治疗,其中男性24例,女性9例,年龄28～81(61.3±19.5)岁,包括累及弓部分支的B型主动脉夹层19例,主动脉弓降部真性动脉瘤7例,主动脉弓降部假性动脉瘤3例,主动脉弓穿透性溃疡3例,主动脉食管瘘1例。所有患者均实施了血管腔内修复,其中12例先进行解剖外旁路手术,16例1期直接覆盖左锁骨下动脉,2例使用覆膜支架近端开槽技术保留左锁骨下动脉,3例使用"烟囱"技术重建左锁骨下动脉或左颈总动脉。结果全组均取得技术成功。术后1例因脑梗塞伴肺炎、肾功能衰竭不治,其余均痊愈出院。30例随访2～52个月,均恢复正常生活。3例出现头晕等窃血表现,在1个月内缓解。术后随访CT血管造影(computerized tomographic angiography,CTA)示:主动脉支架无移位,6例原有内漏已消失,无新的内漏发生,夹层假腔或动脉瘤腔内已有血栓形成,远端夹层假腔无明显扩大,旁路人工血管及"烟囱"支架通畅。结论应用血管腔内修复术治疗主动脉弓降部病变有满意的近期疗效,是治疗此类病变的重要方法。

Endovascular aneurysm repair in treatment of complex aortic arch and descending aorta disease: report of 33 cases

Objective To summarize the preliminary experiences of endovascular aneurysm repair in treatment of complex aortic arch and descending aorta disease.Methods A total of 33 patients with complex aortic arch and descending aorta disease undergoing operation in our hospital from July 2007 to September 2011 were enrolled.They were 24 males and 9 females,with an age ranging from 28 to 81 years old(mean 61.3±19.5).Among them,19 patients had type B aortic dissection involving the aortic arch,7 thoracic aortic aneurysm,3 thoracic pseudoaneurysme,3 patients of penetrating aortic ulcer,and 1 aorticoesophageal fistula.All patients received endovascular aneurysm repair.There were 12 patients receiving the adjunctive surgical bypass in advance,16 patients undergoing the invasion only covering the left subclavian artery without reconstruction,2 restoring flow of the left subclavian artery in way of using scallop stents,and 3 cases being managed with placement of chimney grafts to reconstruct the left subclavian artery or the left common carotid artery.Results Technical success was achieved in all patients.One case was not cured because of postoperative cerebral infarction and renal function failure,and the other were discharged from hospital.During the follow-up period ranging from 2 to 52 months for 30 patients,all of them had a normal life.Dizziness occurred in 3 cases,but rapidly resolved in a month.Computerized tomographic angiography(CTA) during follow-up showed no endoleakage and translocation of the stent grafts.Leaks originally in 6 cases were disappeared,and no more new was discovered.Some thromboses were found in the thoracic aortic false lumen and aneurysm.There was no obvious expansion of the distal part of the dissection.The patency of the bypass grafts and the chimney stents was satisfactory.Conclusion Endovascular aneurysm repair is an effective treatment for complex aortic arch and descending aorta disease with satisfactory short-term outcomes.