模块分叉支架型血管重建犬主动脉弓的可行性研究

目的设计制作腔内重建犬主动脉弓的模块分叉支架型血管,研究其腔内重建主动脉弓的可行性。方法全组10例动物,主动脉造影测量升主动脉、主动脉弓及其分支血管的相关数据,设计并制作适合于重建犬主动脉弓的模块分叉支架型血管;在X线透视引导下,依次自右锁骨下动脉、左锁骨下动脉及股动脉植入支架型血管的三个模块,并在体内对接,完成主动脉弓的重建;观察移植物形态结构、主动脉血流动力学变化及内漏发生状况。结果8例成功完成各模块的植入,另2例分别于术中死于冠状动脉被封堵和左锁骨下动脉破裂。成功完成介入操作的8例动物术中造影结果显示移植物位置及形态良好,冠状动脉及颈总动脉血流通畅,其中2例发现近端I型内漏。结论应用模块分叉支架型血管腔内重建犬主动脉弓在技术方案上是可行的;对腔内重建人体主动脉弓的研究具有指导意义。     

支架自显影定位法体外开窗技术在主动脉弓部腔内修复术中的应用：附113例国际多中心病例回顾性分析

背景与目的：胸主动脉腔内修复术（TEVAR）已成为治疗降主动脉疾病的一线治疗方式。在治疗累及主动脉弓部疾病时,体外开窗（PMF）是目前常用于重建弓部分支动脉的技术之一。它是指在选择合适的主动脉覆膜支架后,根据弓上分支动脉的位置,在覆膜支架相应位置上除去覆膜,建立人造的“窗孔”,在将有窗孔的大动脉支架准确对位释放后再释放分支支架。本文介绍一种利用主动脉支架本身所携带的不透X线标志快速、准确地将窗孔与分支动脉开口对准的开窗方法—支架自显影定位PMF技术（S-F技术）,并通过总结利用该方法进行TEVAR的一组患者临床资料和手术以及随访数据,探讨利用S-F技术在主动脉弓部疾病腔内治疗中的技术特点和其应用价值。 方法：回顾性分析2015年12月—2020年6月利用S-F技术行TEVAR治疗的中国湖南中南大学湘雅二医院血管外科和其他7个国家的国家级血管外科中心共113例主动脉弓部疾病患者的基本数据、术中技术数据和术后随访数据。 结果：患者均根据S-F技术的操作标准流程进行的TEVAR,即时手术成功率为100%,共植入胸主动脉覆膜支架118枚,其中植入桥接支架35例。手术时间（62.9±17.4）min,X线操作时间（23.1±9.8）min,造影剂用量（81.2±22.5）mL。术中开窗对位准确率为98.2%。补救性植入烟囱支架1例（0.9%）,矫正后对位回准1例（0.9%）。开窗同时保留弓上三分支动脉2例（1.8%）,开窗同时保留左颈总动脉（LCCA）和左锁骨下动脉（LSA）6例（5.3%）,保留LSA 110例（97.3%）。术后1个月内无死亡病例,无严重并发症发生。术后1周复查发现Ⅰ型内漏7例（6.2%）。随访时间中位时间24.5个月,死亡2例（1.8%）;术后分支动脉闭塞3例（2.7%）,分别发生在术后3个月（2例）和术后6个月（1例）。 结论：S-F技术为治疗累及主动脉弓部疾病重建弓上分支动脉提供了一种可供选择的方法,是全腔内重建主动脉弓部方法技术上的一项进步。     

球囊扩张式覆膜支架在血管疾病中的应用

回顾性分析2020年7至11月复旦大学附属中山医院系统Lifestream 球囊扩张式覆膜支架应用于治疗血管疾病的9例病例, 年龄39～80(64.3±12.7)岁, 均为男性。共应用10枚Lifestream球囊扩张式覆膜支架, 4枚应用于4例髂动脉硬化闭塞性病变, 1枚应用于腹主动脉夹层动脉瘤腔内修复过程中髂支补救性重建;5枚应用于4例胸、腹主动脉患者腔内修复中内脏及弓上分支动脉重建, 其中植入于肾动脉3枚、2枚分别作为烟囱支架用于左锁骨下动脉和左侧颈总动脉重建。4例髂动脉硬化闭塞性病变中, 完全覆盖病变, 无明显残余狭窄。1例腹主动脉夹层动脉瘤髂支压迫, 经植入Lifestream后完全纠正。4例主动脉病例中, 均完成分支动脉重建, 其中1例主动脉弓假性动脉瘤腔内修复术中应用者(烟囱)出现少量Ⅰ型内漏, 随访1个月后内漏消失。应用Lifestream总体技术成功率及手术成功率为100%, 围手术期无心肌梗死、脑梗死、死亡等重大并发症发生;中位随访时间10个月, 所有靶血管通畅, 无支架移位、断裂、支架内狭窄等支架相关并发症发生。本研究显示Lifestream球囊扩张式覆膜支架适用...     

主动脉腔内修复术中钬激光原位开窗技术的应用(附42例报告)

目的 探讨钬激光原位开窗技术在主动脉腔内修复术中保留弓上分支动脉的疗效.方法 2016年11月 ～2019年7月对42例紧邻主动脉弓部分支血管、腔内修复治疗近端锚定区不足的主动脉病变在DSA下对胸主动脉行腔内隔绝之后,通过肱动脉或颈动脉逆行导入550μm钬激光光纤,对覆膜支架进行原位开窗,开窗后植入支架,重建左锁骨下动...     

血管外科疾病腔内治疗现状与展望

血管外科疾病腔内治疗经过20年蓬勃发展,已经涵盖主动脉夹层、腹主动脉瘤、下肢动脉狭窄闭塞、颈动脉狭窄、深静脉血栓形成等大部分血管疾病的治疗。目前,累及主动脉弓以远的主动脉夹层和肾下型腹主动脉瘤均首选腔内治疗;采用开窗技术、烟囱技术、分支支架等分支动脉重建技术治疗累及重要分支动脉的主动脉病变进展迅速;在采用普通球囊、切割球囊、斑块切除等技术获得通畅血管的基础上,使用药物涂层球囊,必要时结合支架技术治疗慢性下肢动脉缺血性疾病已成为共识;下肢静脉腔内溶栓、下腔静脉滤器、静脉支架植入等腔内技术在下肢深静脉血栓的治疗领域发展迅速。     

Ankura主动脉覆膜支架行原位开窗重建弓上分支的应用

背景与目的 胸主动脉腔内修复术（TEVAR）已经成为治疗主动脉弓部病变的首选术式。然而,此术式要求支架近端安全锚定区至少为15 mm,对于锚定区不足者,则通常需重建弓部分支血管以确保手术安全。在目前各种重建技术中,原位开窗技术因其较大程度的保留分支血管以及较低的内漏风险而应用最多。因此,本研究探讨Ankura主动脉覆膜支架进行原位开窗重建弓上分支的可行性及效果。方法 回顾性分析2017年3月—2020年12月中国科学院大学宁波华美医院收治的47例近端锚定区不足的主动脉病变患者的临床资料。其中胸主动脉夹层38例,胸主动脉瘤6例,胸主动脉溃疡3例。根据术前CTA影像资料决定患者的开窗数目、开窗支架规格,术中利用穿刺针对Ankura主动脉覆膜支架进行原位开窗重建弓部分支,术后定期行主动脉CTA复查随访。结果 所有患者均获手术成功,共植入Ankura胸主动脉覆膜支架47枚,Gore Viabahn覆膜支架51枚,Cordis Smart裸支架20枚。4例术中转烟囱支架植入,原位开窗成功率91.5%（43/47）,包括左锁骨下动脉（LSA）开窗29例,左颈总动脉（LCCA）开窗+LSA栓塞1例,LSA开窗+左椎动脉烟囱1例,LSA开窗+左LCCA烟囱9例,LCCA+LSA开窗+无名动脉（IA）烟囱1例,LCCA开窗+IA烟囱+LSA栓塞2例。全组患者手术时间160~300 min,平均（200±20）min,术中开窗时间18~45 min,平均（30±8）min;术后内漏（1型）3例,逆撕2例（1例行升主动脉置换后好转,1例死亡）,脑梗死2例,截瘫0例。平均随访时间（28.4±14.7）个月,期间2例内漏在随访中消失,1例内漏未进一步增大予以观察随访中,未见开窗分支血管闭塞。结论 利用穿刺破膜技术对Ankura主动脉覆膜支架进行原位开窗重建分支血管是一种切实可行且有效的治疗方式,近期效果良好。     

外分支支架和内分支支架治疗B型主动脉夹层的近期结果及计算流体力学分析

目的：评估外分支支架和内分支支架胸主动脉腔内修复术（thoracic endovascular aortic repair, TEVAR）治疗Stanford B型主动脉夹层（Stanford type B aortic dissection, TBAD）的近期结果,并通过计算流体力学（computational fluid dynamics, CFD）分析两种支架对主动脉夹层血流状态的影响。方法：收集2018年5月至2021年12月天津医科大学总医院血管外科采用外分支支架和内分支支架治疗TBAD病人的临床资料,回顾性分析两组近期治疗结果。基于两组的CT血管造影,各选取1例典型病例构建个性化的三维模型,进行流体力学数值模拟计算。对比分析手术前、后流场速度分布、壁面压力和壁面切应力（wall shear stress, WSS）参数。结果： 共纳入55例TBAD病人,其中外分支支架组49例,内分支支架组6例。两组基线资料差异无统计学意义。两组手术成功率均100%。外分支支架组41例（83.7%）和内分支支架组6例（100%）单纯重建左锁骨下动脉（left subclavical artery, LSA）。外分支支架组5例重建左颈总动脉（left common carotid artery, LCCA）联合颈锁动脉搭桥,2例重建LCCA联合LSA栓塞,1例重建LCCA联合LSA开窗。外分支支架组失访4例。两组围术期及随访期主动脉相关死亡率（P=1.000）、分支支架通畅率（P=1.000）及免于靶血管二次干预率（P=0.298）差异均无统计学意义。两组支架植入术后均显著改善夹层病变内流场紊乱,恢复正常主动脉血流形态,降低局部异常增高的WSS。内分支支架对主动脉弓部及分支血流状态的干扰较外分支明显。结论：外分支支架和内分支支架TEVAR重建LSA,治疗TBAD均有较好近期效果。外分支支架相比内分支支架解剖契合度较高,可较大程度恢复主动脉弓部正常血流状态。     

三分支覆膜支架行主动脉弓重建治疗Stanford A型主动脉夹层效果的临床随访

目的通过长期随访采用三分支覆膜支架重建主动脉弓治疗 Stanford A 型主动脉夹层患者的临床治疗效果,评价三分支覆膜支架行主动脉弓重建的安全性和可行性。方法纳入 2009 年 3 月至 2014 年 6 月我院心脏大血管外科应用三分支覆膜支架治疗的 Stanford A 型主动脉夹层患者 17 例,其中男 11 例、女 6 例,年龄 35~72 岁。观察其临床疗效及并发症发生率以及术后 CT 随访结果。结果三分支主动脉弓覆膜支架治疗组患者随访期间死亡 1 例。术后不同随访时间 64 排 CT 血管造影结果显示支架血管位置满意,支架打开完全,无扭曲及内漏发生。主动脉各分支血管血流通畅,无狭窄及闭塞。3 个月后随访观察到有 8 例假腔血栓形成闭塞,6 个月后随访观察到所有患者假腔全部血栓闭塞。3 年后随访观察到支架稳定,未发生支架扭曲、变形或者断裂情况,假腔消失。结论三分支覆膜支架重建主动脉弓治疗 A 型主动脉夹层临床效果可靠,值得推广应用。     

累及主动脉弓部病变的完全腔内治疗:95例中长期随访结果

目的探讨完全腔内技术治疗累及主动脉弓部病变的中长期随访结果。方法回顾性分析2010年1月~2017年12月95例应用完全腔内技术处理累及主动脉弓部病变的临床资料,其中烟囱支架技术81例,“开窗”技术8例(原位4例,体外4例),分支支架技术6例。结果共植入胸主动脉覆膜支架主体95枚,重建主动脉弓部分支动脉124支,其中无名动脉7支,左颈总动脉36支,左锁骨下动脉81支。2例原位开窗失败中转烟囱技术重建分支。术中Ⅰ型内漏11例(11.6%),其中5例弹簧圈栓塞后消失,6例轻微内漏随访观察。技术成功率91.6%(87/95)。围术期死亡3例(3.2%),一过性截瘫1例(1.1%),脑梗死2例(2.1%),急性心肌梗死2例(2.1%),急性肺损伤1例(1.1%)。存活92例中随访83例,随访率90.2%。1例术后4个月死于脑梗死,1例术后6个月因多器官功能衰竭死亡,其余81例随访时间28~106(58.9±17.9)月,其中73例>36个月。8例因Ⅰ型内漏行二次手术栓塞,未见支架移位、狭窄、闭塞等并发症。结论通过多种完全腔内技术重建各主动脉弓部的分支血管,为累及主动脉弓部病变提供微创治疗机会,中长期随访结果满意。     

单分支支架治疗锚定区不足Stanford B型主动脉夹层

目的探讨应用Castor分支型主动脉覆膜支架治疗健康锚定区不足15 mm的Stanford B型主动脉夹层(TBAD)的临床效果。方法回顾性分析解放军第九七〇医院2017年10月至2018年6月应用Castor单分支型支架治疗18例近端健康锚定区15 mm的TBAD患者的临床资料,其中急性TBAD 17例,慢性TBAD 1例,患者均经CT血管成像(CTA)确诊。结果手术成功率100%,手术平均时间(127.8±20.1)min,均无内漏发生,围术期无脑梗死、夹层动脉瘤破裂等并发症,无死亡病例。术中2例左锁骨下动脉(LSA)分支支架释放后存在狭窄,给予球囊扩张后狭窄解除;1例术后出现左侧肱动脉穿刺点血肿,经保守治疗治愈。随访18例,平均随访时间(8±2)个月,无截瘫及死亡病例,LSA分支支架通畅率为100%,无内漏及夹层逆撕,胸主动脉段真腔直径较术前明显扩大、假腔直径较术前明显缩小(P0.05),胸段假腔术后血栓化率高于腹主动脉。结论 Castor分支型覆膜支架治疗近端健康锚定区不足15 mm的TBAD可以有效重建LSA,操作安全精准,隔绝效果好,短期随访无内漏发生,远期疗效尚需进一步观察。     

Endovascular repair of the half aortic arch in pigs with an improved, single-branched stent graft system for the brachiocephalic trunk

The objective of this study was to evaluate the feasibility of endovascular repair of half of the aortic arch in pigs using an improved, integrated, single-branched stent graft for the ascending aorta and brachiocephalic trunk (BCT). We designed an improved stent graft in an integrated fashion and deployed the stent grafts into the ascending aortas and BCT of eight pigs. The feasibility of the stent graft deployments was evaluated three months after the procedures using arteriography, computed tomography angiography (CTA) and animal autopsy. The stent grafts were successfully deployed in eight pigs. All animals survived for at least three months. Arteriography, CTA and animal necropsy revealed good stent fixation in eight cases. Their head CT scans found no evidence of cerebral infarction. In conclusion, endovascular repair of the half aortic arch with the integrated single-branched stent graft system appears to be safe and feasible in pigs.     

血管腔内支架治疗动脉狭窄性病变的临床分析

目的 初步评价金属内支架治疗动脉狭窄性病变的疗效及安全性。方法 利用血管腔内支架置入共治疗34例动脉狭窄性病变,其中降主动脉1例,髂动脉27例,股动脉2例,颈动脉1例,锁骨下动脉2例,肾动脉1例。动脉硬化性病变33例,多发性大动脉炎1例。动脉经皮穿刺26例,动脉直视下穿刺8例。结果 34例血管腔内支架均置放成功,1例降主动脉段病例于术后当日死亡,系降主动脉破裂。球囊扩张后动脉形成夹层分离有13例,穿刺点血肿形成11例。颈动脉段1例术中及术后未发生TIA及脑梗塞。下肢动脉各段术中及术后未发生远端肢体动脉急性栓塞。踝肱指数从术前平均0．45升至0．72。2例锁骨下动脉病变患者术后患肢血压恢复正常。1例肾动脉狭窄患者血压从术前180／120mm Hg下降至140／90mm Hg。所有存活病例均得到随访,随访1－26个月,2例髂动脉病变分别于术后4个月及6个月血栓形成,余扩张段动脉均通畅。结论 血管腔内支架对动脉狭窄性病变疗效满意,尤其适用于髂动脉、锁骨下动脉短段狭窄的患者。对颈动脉狭窄性病变使用需慎重。     

Graft replacement from ascending aorta to descending aorta with endovascular stent graft under median sternotomy]

We reported a 62-year-old man with DeBakey IIIa dissecting aortic aneurysm involving distal aortic arch who underwent graft replacement from ascending to descending aorta using a endovascular stent graft. Median sternotomy was carried out, because of severe pleural adhesion. Endovascular stent graft composed of 30 mm Gianturco Z stent and 24 mm woven Dacron graft was inserted to descending aorta with the aid of hypothermia, systemic circulation arrest and selective cerebral perfusion. Transesophageal echocardiography was used to measure the diameter and the length of descending aorta and the graft. And ascending and total aortic arch replacement was performed with four branched woven Dacron graft. Postoperative chest CT and aortography showed satisfactory reconstruction with the thrombosed false lumens. We think placement of stent graft to descending aorta through median sternotomy is useful method when left thoracotomy is impossible or distal anastomotic site is too far for the anastomosis.     

Percutaneous aortic valve replacement: an experimental study. I. Studies on implantation

OBJECTIVE: The purpose of this preliminary study was to devise a new surgical procedure for minimally invasive aortic valve implantation with a transluminal technique. METHODS: The new collapsible heart valve was prepared by mounting a porcine aortic valve, taken from a freshly slaughtered pig, into a self-expandable nitinol stent by means of a suture technique. The outer diameter of the valved stent ranged from 15 to 23 mm, and the length ranged from 21 to 28 mm. Before implantation in vivo, these valved stents were tested in an in vitro circulatory system. Only in vitro-tested valved stents with a pressure gradient of less than 7 mm Hg and regurgitation of I degrees or less were used for transluminal aortic valve implantation in vivo. Six of these valved stents were implanted in the descending aorta and 8 in the ascending aorta of anesthetized pigs. The catheter delivery system (22F) was extraperitoneally inserted through the left iliac artery or the infrarenal aorta. Measurements for transvalvular gradient, valvular opening and closure, blood-flow characteristics, regurgitation, and macroscopic analysis were performed at baseline and after the observation period (164 +/- 48 minutes). RESULTS: This preliminary study contained 14 animals. One animal died of ventricular fibrillation. Technical failure occurred in 2 pigs as a result of stent twisting. At the end of the observation period, the 11 successfully implanted valved stents demonstrated low transvalvular gradients (mean end-systolic Deltarho(max) of 5.4 +/- 3.3 mm Hg for the descending aorta group, 5.4 +/- 1.2 mm Hg for the supracoronary group, and 5.4 +/- 1.1 mm Hg for the subcoronary group), which did not differ from their in vitro gradients. Two-dimensional echocardiography demonstrated complete valvular closure and opening in 5 of 5 cases. Angiography indicated only a physiologic jet of regurgitation (0 degrees ) in 8 animals and mild (I degrees ) regurgitation in 3 animals. Color Doppler ultrasonography indicated no regurgitation in 5 of 5 cases and minor paravalvular leakage in 1 case. CONCLUSION: Aortic valved stents can be successfully implanted without thoracotomy by using a transluminal catheter technique. Long-term function of the valves remains to be established.     

Type II endoleak in porcine model of abdominal aortic aneurysm

PURPOSE: The purpose of this study was to develop a reliable in vivo porcine model of type II endoleak resulting from endovascular aortic aneurysm repair (EVAR), for the study and treatment of type II endoleak. METHODS: Eight pigs underwent creation of an infrarenal aortic aneurysm, with a Dacron patch with preservation of lumbar branches. An indwelling pressure transducer was placed in the aneurysm sac. After 1 week the animals underwent EVAR with a custom-made Talent endograft. After another week the animals underwent laparoscopic lumbar artery ligation. Abdominal and pelvic computed tomography was performed after each procedure. Aneurysm sac pressure was measured in sedated and awake animals. RESULTS: All eight animals underwent successful creation of an aortic aneurysm and EVAR resulting in exclusion of the aneurysm sac. After creation of the aneurysm the sac mean arterial pressure (MAP) was 72.5 +/- 6.1 mm Hg and the sac pulse pressure was 44.8 +/- 8.7 mm Hg. Postoperative computed tomography scans demonstrated a type II endoleak from the lumbar branches in all animals. While aneurysm sac MAP (56.5 +/- 7.9 mm Hg; P <.01) and pulse pressure (13.6 +/- 4.1 mm Hg; P <.01) decreased after EVAR, sac pulse pressure remained, with type II endoleak. All animals underwent laparoscopic lumbar artery ligation, which resulted in further reduction in the sac MAP (38.3 +/- 4.6 mm Hg; P <.02) and immediate absence of sac pulse pressure (0 mm Hg; P <.01). Necropsy confirmed the absence of collateral flow in the aneurysm sac, with fresh thrombus formation in all animals. CONCLUSION: We present a reliable and clinically relevant in vivo large animal model of type II endoleak. CLINICAL RELEVANCE: We set out to show that aortic aneurysm sac pressurization caused by lumbar arterial flow in the setting of type II endoleak can be reproduced in an in vivo porcine model of endovascular aortic aneurysm repair. Indeed, in this model the aneurysm sac pulse pressure was a sensitive indicator of type II endoleak, correlating well with findings at computed tomography, and lumbar artery ligation eliminated the endoleak, as demonstrated on computed tomography scans and sac pressure measurement. Therefore we believe this in vivo large animal model can be instrumental in the study of many aspects of the physiologic features of type II endoleak.     

Anesthetic management for distal aortic arch aneurysm stent grafting

A 76-year-old woman with thoracic aortic aneurysm involving distal aortic arch was scheduled for graft replacement from ascending to proximal aortic arch with endovascular stent graft to descending aorta. Surgical procedures were performed under median sternotomy with hypothermic systemic circulation arrest and selective cerebral perfusion. The stent graft composed of 30 mm Gianturco Z stent and 27.5 mm woven Dacron graft was introduced into the descending aorta under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. Ascending and proximal aortic arch replacement was then performed with four branched woven Dacron graft. The aortic pathology was confirmed by TEE and the extent of the aneurysmal lesion was defined. TEE was also useful to find the dislodgement of the stent graft after deployment. This surgical technique, being less invasive than conventional thoracotomy, would be indicated for elderly patients with distal aortic arch aneurysm. TEE is the vital imaging technique for placement of the stent graft, as well as for intraoperative cardiac monitoring.     

Endovascular repair of the aortic arch in pigs by improved double-branched stent grafts

Introduction

This study aimed to evaluate the feasibility of total endovascular repair of the aortic arch in pigs using improved integrated double-branched stent grafts.

Methods

Improved self-expandable stent grafts with a main body and two integrated branches were prepared for the repair of the aortic arch in six pigs. The feasibility of using these stent grafts was evaluated with arteriography, computed tomography (CT), computed tomography angiography (CTA) and autopsy three months following the procedure.

Results

The double-branched stent grafts were placed successfully in the aortic arch in all six pigs. All pigs survived for at least three months and their biological behaviour was normal. Arteriography, CTA and animal necropsy revealed good fixation in all cases. Aortic valve function and coronary ostia remained intact, and CT of the head did not detect any lesion of cerebral infarction.

Conclusions

Endovascular repair of the aortic arch with an integrated double-branched stent graft is safe and feasible in animal studies.     

Thoracic endograft positioning and carotid-subclavian bypass grafting in a patient with a saccular aneurysm at the aortic arch

A 75-year-old man was referred to our hospital because of sudden thoracic pain. A saccular aneurysm of the aortic arch extending on the anterior surface of the aortic arch was found on computed tomographic arteriography. The patient was hemodynamically stable and he was programmed for a staged surgical and endovascular approach (hybrid approach). As a first stage and in order to prevent major cardiac complications due to the overstenting of the left subclavian artery (LSA) with the occlusion of the aortocoronary bypass, the patient underwent a polytetrafluoroethylene bypass graft (GORE-TEX, W.L. Gore & Associates, Flagstaff, AZ) between the LSA and the left carotid artery. Intraoperative arteriography revealed a good patency of the left carotid-subclavian bypass and of the left internal mammary bypass on the left anterior descending artery. As a second stage the endovascular procedure was accomplished 5 days later in the operating room. A Gore TAG stent graft (W.L. Gore & Associates) was deployed in the aortic arch 20 mm proximally to the aneurysmatic segment covering the ostium of the LSA. The postoperative course was uneventful and the patient was discharged on the fifth postoperative day in good general conditions. Hybrid procedures for treatment of aneurysms of the aortic arch or of the descending thoracic aorta are a promising alternative to open surgery especially in high-risk patients, with lower early morbidity and mortality rates. Long-term effectiveness remains to be fully elucidated.     

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。     

Successful treatment of an infected thoracic endovascular stent graft

A 70-year-old man with a chronic type B aortic dissection was treated with two stent grafts deployed in the descending thoracic aorta. The patient was re-admitted to the hospital at 16 months after thoracic endovascular stent grafting because of a high fever. A blood culture showed sepsis due to a Staphylococcus species. A CT scan showed an increase in the size of the thrombosed false lumen. Complete excision of the infected descending aortic wall and infected stent graft were performed. The descending thoracic aorta was reconstructed using a rifampicin-bonded Dacron graft and omental wrapping. The combination of in situ graft replacement using a rifampicin-bonded graft and omental wrapping is considered an effective treatment for thoracic stent graft infection.