腔内隔绝术联合开窗技术治疗累及主动脉弓部的Stanford B型夹层动脉瘤的临床研究

目的 总结腔内隔绝术联合开窗技术治疗累及主动脉弓部的Stanford B型夹层动脉瘤的可行性和手术效果.方法 采用腔内隔绝术联合开窗技术治疗10例累及主动脉弓部的Stanford B型夹层动脉瘤.腔内隔绝术联合开窗技术封堵夹层破口,保留主动脉弓全部分支8例,保留头臂干及颈总动脉2例.手术均在局部麻醉下完成,覆膜支架开窗在术中进行.结果 患者术中造影无内漏,术后无死亡,2例左锁骨下动脉封堵的患者未出现神经系统并发症.随访中,开窗支架通畅,无移位,保留的主动脉弓分支动脉通畅,降主动脉真腔扩大,假腔血栓化并缩小.结论 对于累及主动脉弓部的Stanford B型夹层动脉瘤,腔内隔绝术联合开窗技术治疗是安全有效的治疗方法.     

不开胸“杂交”手术治疗主动脉弓部夹层的近中期随访研究

目的总结不开胸"杂交"手术(不开胸主动脉弓分支血管旁路术+主动脉腔内修复术)治疗主动脉弓部夹层的近中期疗效和经验。方法回顾性分析2011年1月至2014年9月在广州军区武汉总医院心胸外科接受主动脉弓分支血管旁路术+主动脉腔内修复术(主动脉弓分支血管旁路术毕即转入导管室行同期主动脉腔内修复术)治疗主动脉弓部夹层7例患者的临床资料,其中男12例、女5例,年龄46~71岁。分析该手术方式的选择及预后情况。结果行左颈总动脉-左锁骨下动脉旁路术4例,右颈总动脉-左颈总动脉-左锁骨下动脉旁路术3例,右颈总动脉-左颈总动脉旁路术、封闭左锁骨下动脉10例。全部手术均获得成功。1例患者术后出现喉返神经损伤。术后7 d、3个月、1年及之后每年复查CT,随访截至2015年9月,随访时间12~53个月。随访所有患者均健康存活,人工血管旁路通畅,血管支架无内漏。结论不开胸"杂交"手术可用于治疗难以耐受主动脉置换的主动脉弓部主动脉夹层高危患者。     

一期杂交手术治疗累及主动脉弓远端的降主动脉病变

目的总结一期杂交手术治疗累及主动脉弓远端的B型主动脉夹层及降主动脉瘤的临床经验,探讨一期杂交手术的适应证,分析早期随访结果。方法自2008年10月至2010年5月,北京阜外心血管病医院共有16例累及主动脉弓远端的B型主动脉夹层或降主动脉瘤患者在杂交手术室完成一期杂交手术,其中男12例,女4例;年龄38.0~67.0岁（54.0±9.2岁）。B型主动脉夹层14例,降主动脉瘤累及主动脉弓1例,主动脉弓穿通性溃疡1例。急性发病10例,慢性发病6例。采用颈部切口头臂动脉旁路移植联合股动脉切口逆行主动脉腔内覆膜支架植入,其中左颈总动脉至左锁骨下动脉旁路移植4例,右颈总动脉至左颈总动脉旁路移植11例,右颈总动脉至左颈总动脉及左颈总动脉至左锁骨下动脉旁路移植1例。术后观察患者住ICU时间、住院时间、并发症发生情况;术后3个月、术后1年随访CT资料,观察支架和人工血管通畅情况。结果围术期无死亡和严重并发症发生。所有患者均成功一期完成手术,并植入覆膜支架,术中心血管造影证实各吻合口通畅,支架无明显内漏和移位。有1例患者术后出现轻度偏瘫,经对症处理后迅速好转。术后呼吸机使用时间为2.0~10.0 h（5.3±2.7 h）,住ICU时间0.0~2.0 d（1.1±0.4 d）,住院时间4.0~7.0 d（5.3±0.8 d）,血液制品（包括红细胞、血浆、血小板和白蛋白）使用费用0.0~1 016.5元（134.5±281.8元）。随访16例,随访时间3.0~26.0个月（13.0±5.1个月）,所有患者均生存,恢复正常生活。术后3个月和术后1年复查主动脉增强CT示：支架无移位和内漏,移植的人工血管通畅,远端夹层假腔无明显变化,9例患者支架远端夹层有部分血栓形成。结论一期杂交手术安全、有效,能明显缩短手术时间和住院时间,减轻患者的创伤和痛苦,降低分期手术间隔期的风险,取得了满意的效果;该术式扩大了单纯介入覆膜支架腔内治疗的适应证;杂交手术的中、远期疗效尚须进一步随访。     

腔内修复联合辅助技术治疗累及主动脉弓的Stanford B型夹层动脉瘤

目的 探讨主动脉腔内修复手术联合辅助技术治疗累及主动脉弓部的Stanford B型主动脉夹层动脉瘤.方法 分析腔内治疗累及主动脉弓部,破口邻近左锁骨下动脉或位于其近端的46例StanfordB型主动脉夹层动脉瘤的临床资料.腔内封堵左锁骨下动脉43例;PDA封堵器封堵左锁骨下动脉6例次;颈部动脉搭桥术9例次;“烟囱”技术重建左颈总动脉8例次;“开窗”技术封堵夹层破口,同时保留主动脉弓部所有分支动脉1例次.结果 患者术后均存活,随访时间(25±16)个月.未发生严重神经系统并发症.10例发生左锁骨下动脉Ⅱ型内漏,其中6例通过PDA封堵器隔绝,2例保守治疗后自愈;9例发生左上肢缺血症状,其中8例行保守治疗,另1例症状严重,行颈部动脉搭桥术重建左锁骨下动脉.随访中,所有人工血管和分支动脉支架均保持通畅,降主动脉真腔直径显著扩大,假腔直径逐渐缩小.结论 对累及主动脉弓部,破口邻近左锁骨下动脉或位于其近端的StanfordB型主动脉夹层,腔内治疗联合PDA封堵器、颈部动脉搭桥术、“烟囱”技术或“开窗”技术是安全有效的治疗方法.     

主动脉弓部病变杂交手术后并发症的原因分析及处理

目的 对主动脉弓部病变杂交手术后常见并发症的发生原因进行分析.方法 对2001年1月至2008年12月接受杂交手术的34例主动脉弓部病变患者的资料进行回顾性分析.其中男性28例,女性6例,年龄34～75岁,平均年龄56.7岁.主动脉央层27例,其中A型21例,B型6例;主动脉弓部真性动脉瘤7例.杂交手术包括升主动脉-无名动脉-左颈总动脉Y形旁路3例,升主动脉-左颈总动脉-左锁骨下动脉Y形旁路2例,升主动脉-左颈总动脉旁路连同冠状动脉旁路移植1例,左颈总动脉-右颈总动脉旁路13例,右颈总动脉-左颈总动脉及左颈总动脉-左锁骨下动脉旁路3例,左锁骨下动脉-左颈总动脉-右颈总动脉Y形旁路2例,左颈总动脉-左锁骨下动脉旁路9例.一期行腔内修复26例,分期行腔内修复8例.结果 总的并发症发生率为32.4%(11/34),其中致死性并发症发生率11.8%(4/34).并发症包括主动脉央层破裂1例,脑卒中2例,吻合口漏并假件动脉瘤2例,心肌梗死1例,肺栓塞1例,颈部血肿1例,内漏3例.除4例围手术期死亡外,其余病例随访6～50个月,平均28.6个月,均健康生存.结论 肤主动脉弓部病变杂交手术后的并发症较一般腔内修复术更为多见,降低致死性并发症的发生率是该手术获得进一步推广的关键.     

激光原位开窗联合胸主动脉腔内修复术12例

目的探讨体内激光原位开窗联合胸主动脉腔内修复术治疗累及主动脉弓部甚至升主动脉的主动脉疾病的近期疗效。方法 2016年11月~2017年1月我科对12例累及主动脉弓部甚至升主动脉的主动脉疾病应用体内激光原位开窗技术进行覆膜支架腔内修复术,其中Stanford B型主动脉夹层7例,Stanford A型主动脉夹层2例,升主动脉合并主动脉弓部动脉瘤1例,升主动脉穿透性溃疡合并壁内血肿2例。左锁骨下动脉开窗7例,左颈总动脉+左锁骨下动脉开窗1例,头臂干+左颈总动脉+左锁骨下动脉开窗4例。急性期手术5例,慢性期手术7例。结果植入锥形大动脉覆膜支架12枚,Fluency plus直管型覆膜支架21枚。围手术期死亡2例(16.7%,2/12),其中术中升主动脉破裂死亡1例(8.3%,1/12),术后因消化道大出血合并多脏器功能衰竭死亡1例。术后早期并发症发生率16.7%(2/12),分别为短暂性神经功能障碍1例、呼吸功能不全合并肺部感染1例,经治疗后均痊愈出院。术后3个月随访显示夹层破口(或溃疡、动脉瘤)隔绝良好,无内漏,开窗血管通畅。结论激光原位开窗联合胸主动脉腔内修复术治疗累及主动脉弓部甚至升主动脉的主动脉疾病安全、有效,具有创伤小、恢复快、术中成功率高、内漏发生率低等优点,近期效果良好。     

经颈动脉腔内技术重建主动脉弓治疗Stanford A型夹层动脉瘤(附1例报告)

目的探讨血管腔内技术重建主动脉弓治疗升主动脉、主动脉弓病变的可行性。方法2005年,对1例StanfordA型夹层动脉瘤,腔内修复主动脉病变之前做右颈总动脉-左颈总动脉-左锁骨下动脉的旁路术;经右颈总动脉将修改的分叉支架型血管主体放入升主动脉,长臂位于无名动脉。短臂应用延长支架型血管延伸至降主动脉。通过腔内技术重建主动脉弓实现累及升主动脉和主动脉弓主动脉病变的微创治疗。结果腔内修复术后移植物形态良好,血流通畅,病变被隔绝,脑、躯干、四肢循环稳定。无严重并发症。结论该手术方案设计合理、技术可行。可能成为复杂胸主动脉病变新的腔内治疗模式。     

Stanford A型主动脉夹层的腔内修复术后并发症分析

目的总结Stanford A型主动脉夹层(TAAD)腔内修复术后常见并发症的诊治经验。方法对2001年1月至2012年5月接受腔内治疗的58例TAAD患者资料进行回顾性分析。平均年龄54.3(41～79)岁。35例单纯接受腔内治疗,23例接受杂交手术:升主动脉-左颈总动脉-左锁骨下动脉旁路3例,左颈总动脉-左锁骨下动脉旁路3例,右颈总动脉-左颈总动脉旁路15例,左锁骨下动脉-左颈总动脉-右颈总动脉旁路2例。结果总技术成功率为98.3%(57/58)。并发症包括内漏14例,脑卒中5例,支架源性新破口1例,血管旁路术后吻合口假性动脉瘤2例。术后30天内死亡7例。随访(35.5±5.4)个月,随访期间死亡2例,其余患者均健康生存。结论 TAAD腔内治疗后并发症较累及降主动脉疾病的腔内修复术更为常见,脑卒中是重要的致死性并发症,应引起足够重视。     

升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变

目的 总结升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变的经验与体会.方法 回顾性分析2002年1月至2013年6月在中山大学附属第一医院血管外科接受升主动脉-颈动脉旁路联合腔内修复术治疗的10例主动脉弓部病变高危患者的临床资料.其中男性9例,女性1例,年龄34 ～71岁,平均年龄(54±14)岁.原发病包括主动脉夹层8例,胸主动脉瘤2例.行正中开胸行升主动脉-无名动脉-左颈总动脉旁路7例,升主动脉-左颈总动脉-左锁骨下动脉旁路3例,同期(5例)或二期[5例,平均间隔(7±4)d]经股动脉植入覆膜支架修复主动脉弓病变.结果 全部手术取得技术成功.术后30 d死亡3例,1例死于脑干梗死,1例死于循环衰竭,1例死于主动脉气管瘘.术后发生Ⅱ型内漏1例.随访1 ～ 132个月,中位随访时间24个月(四分位数间距14个月),术后1个月、3个月、1年及其后每年复查CT,随访期间7例患者均健康存活、人工血管旁路通畅,除1例Ⅱ型内漏继续存在外,其余支架均无移位和内漏.结论 升主动脉-颈动脉旁路联合腔内修复术可用于治疗一般情况差、难以耐受主动脉置换的主动脉弓部疾病高危患者.     

杂交手术技术在复杂型Stanford B型主动脉夹层及其并发症治疗的临床研究

目的探讨杂交手术治疗复杂型Stanford B型主动脉夹层的可行性。方法自2011年8月至2015年8月期间,笔者所在医院共有14例复杂型Stanford B型主动脉夹层患者完成腔内修复术(thoracic endovascular aortic repair,TEVAR)并行杂交手术治疗。其中男11例,女3例;年龄(44±7.2)岁(22~62岁)。12例患者夹层动脉瘤累及主动脉弓部及其三大分支血管,其中2例TEVAR手术患者分别于术后3年和5年支架近端新发夹层或假性动脉瘤形成行开胸杂交手术治疗;3例为累及左颈动脉行颈-颈杂交术;7例为累及左锁骨下动脉行颈-锁杂交术。另2例夹层动脉瘤累及髂动脉且合并血栓形成导致下肢缺血,行股-股杂交术。结果所有患者均成功完成覆膜支架的置入并行杂交手术。术中血管造影见支架释放位置准确,夹层隔绝成功,支架无明显内漏和移位,主动脉夹层真腔血流恢复正常,旁路及目标血管血流通畅。14例患者术后均获随访,随访时间为(24.0±8.2)个月(3~36)个月;术后2 d出现脑卒中1例,术后10 d出现切口下血肿1例,术后1个月出现胸腔积液1例,其余患者围手术期无死亡和严重并发症发生。随访的14例患者均恢复正常生活。结论对于复杂型Stanford B型主动脉夹层患者实施杂交手术可以增加TEVAR术的成功率及其使用范围,早、中期效果满意。     

胸主动脉夹层腔内治疗相关并发症的处理

目的 回顾血管腔内修复术(EVAR)治疗胸主动脉夹层后相关并发症的治疗经验,探讨并发症发生原因和处理中存在的问题.方法 回顾性分析2002年7月至2008年3月胸主动脉瘤夹层stanford B型EVAR术后相关并发症33例,其中男性21例,女性12例,平均年龄46.3岁.EVAR术后最长6个月,平均12.3 d.并发症包括左颈总动脉闭塞5例,内漏5例,下肢动脉损伤4例,支架血管植入假腔3例,支架远端逆行性夹层3例,继发A型夹层2例,肢体动脉栓塞2例,以及肱动脉假性动脉瘤和脑血管意外、植入物感染等.除保守治疗外,行二期支架植入13例,颈-颈动脉和颈-锁骨下动脉转流7例,髂股动脉修补或移植4例,动脉取栓1例,经腹主动脉假腔开窗2例,转为升主动脉置换1例.结果 随访结果显示,二期支架植入后内漏消失,动脉转流术后中枢神经系统、肢体及肠管缺血明显改善,逆行性夹层消失.1例A型夹层死于急性心包填塞,1例死于脑出血.结论 对于EVAR术后并发症必须及早处理,采用血管腔、内外治疗相结合措施可提高成功率.     

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??Therapeutic effect of situ fenestration by laser in intracavitary with stent covered a membrane implantation in the treatment of Stanford type A aortic dissection??aneurysm?? WEI Li-chun*,ZHANG Yu-xia,,HOU Pei-yong,et al.Department of Vascular Surgery, Liuzhou Worker's Hospital, Liuzhou 545005,China
Corresponding author??HOU Pei-yong, E-mail:zxp19841223@126.com
Abstract Objective To investigate the short-term efficacy of aortic arch repair in combination with situ fenestration by laser in intracavitary with stent covered a membrane implantation in the treatment of Stanford type A aortic dissection??aneurysm??. Methods Seven cases of Stanford type A aortic dissection??aneurysm??were treated with vivo repair of lumbar stent by laser in situ windowing technique in Liuzhou Worker's Hospital from November 2016 to May 2017. The 7 cases included 4 cases of intraoperative brachiocephalic trunk and left common carotid artery and left subclavian artery fenestration??2 cases of brachiocephalic trunk and left common carotid artery fenestration??1 case of left common carotid artery and left subclavian artery fenestration. Acute surgery was performed in 5 cases and chronic surgery in 2 cases. Results Thirteen conical aortic stent and fluency plus straight stent grafts were implanted in all the cases. There was one case ??14.3%?? died of intraoperative ascending aorta rupture and the incidence of early postoperative complications was 28.6%. All the cases were cured and discharged through treatment.The whole results of one month and three months follow-up showed the rupture of dissection ??aneurysm?? isolated?? no endoleak?? window smoothing . Conclusion Aortic arch internal fixation combined with intraocular laser in situ stent implantation is safe and effective in the treatment of Stanford type A aortic dissection??aneurysm??. It has the following advantages of less trauma?? quick recovery?? high intraoperative success rate?? low incidence of endoleak?? which has good recent results. However??long-term efficacy still need further follow-up to confirm.     

Endovascular repair of a ruptured thoracic aortic dissection with a right sided aortic arch: A case report

BackgroundEmergency treatment of complex aortic pathology is challenging in the setting of a right-sided aortic arch. We report the successful treatment of a ruptured thoracic aortic aneurysm (TAA) in the setting of a Stanford type B aortic dissection (TBAD) and right-sided aortic arch.Presentation of caseThe patient is a 66-year-old male with chronic kidney disease (CKD) admitted with right sided chest pain and hypotension. Computed tomography angiography (CTA) revealed a 5 cm ruptured TAA in the setting of a TBAD and right-sided aortic arch. The TBAD began just distal to the right common carotid artery and involved the origin of the left subclavian artery (SCA). Using a totally percutaneous approach, a conformable Gore^® TAG^® thoracic endoprosthesis was placed in proximal descending thoracic aorta covering the left SCA. Aside from progression of his pre-existing CKD, the patient had an uneventful recovery. CTA one-month post-procedure revealed a type IB endoleak with degeneration of the distal descending thoracic aorta. To exclude the endoleak, the repair was extended distally using a Medtronic Valiant^® thoracic stent graft. The left subclavian artery was subsequently coil embolized to treat an additional retrograde endoleak. The patient has done well with no further evidence of endoleak or aneurysm expansion.ConclusionRight-sided aortic arch presents challenges in the emergency setting. CTA and post-processing reconstructions are very helpful. While the endoleaks prompted additional interventions, the end result was excellent. This case displays the importance of careful attention to detail and follow-up in these complicated patients.     

改良全弓置换加支架象鼻术在DeBakeyⅠ型主动脉夹层术中的应用

目的 总结改良主动脉全弓置换加支架象鼻术治疗DeBakey Ⅰ型主动脉夹层的临床经验.方法 2006年1月至2010年10月,101例DeBakey Ⅰ型主动脉夹层患者接受改良全弓置换加支架象鼻术,其中急诊手术73例.全组男性76例,女性25例;年龄21～77岁,平均(49±8)岁.手术包括升主动脉置换术31例、Bentall术29例、Wheat术7例、David术34例.支架象鼻术的同时行左锁骨下动脉开窗以重建血运.在深低温停循环时改行双侧顺行脑灌注下完成脑保护.结果 手术改良后平均心肺转流时间(212±40)min,平均心肌阻断时间(95±16)min,平均停循环时间(42±8)min.手术死亡1例,住院死亡5例,分别死于感染败血症、急性肾功能衰竭、偏瘫并发多器官功能衰竭.双侧脑灌注后脑血管意外和短暂脑神经功能障碍的发生率低于选择性脑灌注.76例患者出院前复查主动脉CT血管造影,人工血管无扭曲,血流通畅,胸降主动脉夹层假腔闭合率为78.9%.71例随访5～49个月,其中50例复查CT血管造影,胸降主动脉夹层假腔闭合率为88.0%,无晚期死亡及再次手术者.结论 改良的全弓置换加支架象鼻术治疗DeBakey Ⅰ型主动脉夹层安全、有效,可减少术后并发症.

Abstract：

Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010, 101 cases of DeBakey Ⅰ aortic dissection were treated by modified total arch replacement and stent elephant trunk technique, in which emergency surgery for 73 cases. There were 76 male and 25 female patients, aged from 21 to 77 years with a mean of(49 ±8)years. Intraoperative ascending aortic replacement in 31 cases, Bentall procedure in 29 cases, Wheat procedure in 7 cases, David procedure in 34 cases. At the same time stent elephant trunk in the left subclavian artery corresponding position was windowed to rebuild the blood supply. Deep hypothermic circulatory arrest cerebral protection was completed by bilateral antegrade cerebral perfusion. Results The mean cardiopulmonary bypass time was(212 ±40)min, mean myocardial occlusion time was(95 ± 16)min, mean circulatory arrest time was (42 ±8)min. Operative mortality was 1 case and hospital mortality was 5 case, which died of septicemia,acute renal failure and hemiplegia complicated with multiple organ failure. Compared with selective cerebral perfusion, the incidence of postoperative cerebral vascular accident and transient neurological dysfunction decreased. Seventy-six cases received aorta CTA before discharged, the closure rate of descending thoracic aortic dissection false lumen was 78. 9%. Seventy-one patients were followed up for 5 to 49 months, 50cases was reviewed by CTA, of which closure rate of descending thoracic aortic dissection false lumen was 88.0%, no late death and re-surgery. Conclusions The modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey Ⅰ thoracic aortic dissection was safe and effective, with less postoperative complications.     

Double-chimney technology for treating secondary type I endoleak after endovascular repair for complicated thoracic aortic dissection

Endovascular repair continues to pose a formidable technical challenge in the cases of aneurysm, dissection, and proximal type I endoleak involving the aortic arch. During the process of covering the aortic arch by stent graft to achieve better sealing, maintaining blood flow to the vital supra-aortic branches is difficult. We present a case of successful endovascular treatment of secondary type I endoleak by a double-chimney technique in a 36-year-old woman who had previously undergone a complicated descending aortic dissection repair. This endovascular technology might offer a new option to simultaneously preserve the innominate artery and the left carotid artery for total reconstruction of the aortic arch.     

Total Endovascular Debranching of the Aortic Arch

Background

Significant morbidity and mortality are related to conventional aortic replacement surgery. Endovascular debranching techniques, fenestrated or branched endografts are time consuming and costly.

Objective

We alternatively propose to use endovascular approach with parallel grafts for debranching of aortic arch.

Methods

Under general anesthesia, 12 F sheaths were inserted in the femoral, axillary and common carotid arteries for vascular accesses. ViaBahn grafts 10 – 15 cm in length were placed into the aortic arch from right common carotid, left common carotid and left axillary arteries, until the tip of each graft reached into the ascending aorta. Through one femoral artery, the aortic stent –graft was positioned and delivered. Soon after, the parallel grafts were sequentially delivered. Self-spanding Wallstents^R were used for parallel grafts reinforcement. Ballooning was routinely used for parallel grafts and rarely for aortic graft.

Results

This technique was used in 2 cases. The first one was a lady with 72 years old, with an aortic retrograde dissection from left subclavian artery and involving remaining arch branches. Through right common carotid artery a stent-graft was placed in the ascending aorta and through the left common carotid artery a ViaBahn was inserted parallel to the former. A thoracic endograft then covered all the aortic arch dissection extending into the ascending aorta close to the sinu –tubular junction. The second case was a 82 year old male patient with a 7 cm aortic arch aneurysm. Through both common carotid arteries ViaBahn grafts were introduced and positioned into the ascending aorta. Soon after, the deployment of the thoracic stent graft covered all parallel grafts of the aortic arch, excluding the aneurysm. Both cases did not have neurologic or cardiac complications and were discharged 10 days after the procedure.

Conclusions

This technique may be a good minimal invasive off-the-shelf technical option for aortic arch ‘‘debranching’’. More data and further improvements are required before this promising technique can be widely advocated.     

累及弓部主动脉夹层手术方式选择及疗效

目的:探讨累及主动脉弓部主动脉夹层手术方式选择及疗效。方法:收集2010年2月—2015年5月因主动脉弓部夹层在广州军区武汉总医院心胸外科接受手术治疗病例资料,分析其手术方式选择及理由,不同术式并发症发生率等。结果:检索出符合条件的病例92例,其中仅行胸主动脉腔内修复术(TEVAR)36例,预开窗血管支架的TEVAR 2例,封闭左锁骨下动脉的TEVAR 31例,不开胸主动脉弓分支血管旁路术+TEVAR17例(左颈总动脉-左锁骨下动脉旁路术4例,右颈总动脉-左颈总动脉-左锁骨下动脉旁路术3例,右颈总动脉-左颈总动脉术、封闭左锁骨下动脉10例),开胸主动脉弓置换术6例。2例开胸主动脉弓置换术患者术后死亡,其余术后无严重并发症发生。结论:对于累及主动脉弓部夹层,开胸主动脉弓置换术是一种成熟的治疗方式;TEVAR是的一种快速、有效、经济、术后并发症少的手术方式,并可以通过开窗、分支血管旁路术等方式扩大其应用范围。