分支型腔内支架人工血管治疗B型主动脉夹层

目的 应用主动脉-左锁骨下动脉分支型支架人工血管治疗累及左锁骨下动脉的主动脉弓部夹层。方法2004年2月至2005年1月，采用北京裕恒佳科技有限公司制作的血管腔内分支型主动脉支架人工血管治疗主动脉弓部B型夹层病人42例。原发破裂口位于左锁骨下动脉开口远侧2cm以内。分支型支架由主动脉支架和左锁骨下动脉支架组合而成。支架直径较相应支撑部位动脉直径增加15％～20％。治疗在血管造影室进行，分支型支架人工血管经送放器送入动脉，在透视下释放，植入主动脉弓和左锁骨下动脉。结果41例（98％）成功放置分支型支架41只和直筒型可弯曲支架人工血管5只；1例因左锁骨下动脉变形成角未能将送放器送入而改用直筒型支架治疗。夹层破裂口均被封闭，夹层真腔全部恢复正常直径。术后复查2例存在少量内漏。入路动脉无损伤，无死亡病例。术后病人均恢复正常活动。结论主动脉-左锁骨下动脉分支型支架人工血管易使用，适合修复破裂口位于左锁骨下动脉开口旁的主动脉弓部夹层，但长期效果还需进一步观察。

Aorta-left subclavian artery branched endovascular stent-graft repair for Stanford type B aortic dissection

Objective Endovascular tubular stent grafting has emerged as an alternative therapeutic modality for patients with aortic dissections. However, its application has been limited to the descending thoracic aorta distal to the origin of the left subclavian artery. The initial clinical experience of endovascular branched stent graft repair for aortic arch dissections involving the left subclavian artery was reported. Methods From February 2004 to January 2005, the endovascular branched aortic stent-grafts made by Beijing YuHengJia SciTech Co. were applied in 42 patients with Stanford type B aortic dissection with the entry tears just beyond (<2cm) the origin of the left subclavian artery. The branched stent consists of the aortic section and the branched section. The diameter of the stents was 15% to 20% larger than the diameter of the landing zones of native arteries. The branched stent grafts were delivered under fluoroscopic guidance and implanted into the aortic arch including the left subclavian artery. Results In 42 patients, 41 branched stent-grafts and 5 additional tubular stent-grafts were delivered successfully in 41 cases (98%) except one failure for an angled left subclavian artery. The entry tears were excluded completely, and the truth lumen of the dissection was revealed to the normal diameter in all patients. In 2 of 41 branched-stented cases remained mild endoleaks. Neither peripheral complication, nor death occurred. All 41 patients have restored normal life. Conclusion This report demonstrates the technical feasibility of endovascular branched aortic stent graft repair for the intimal tear of dissection just beyond the left subclavian artery. Longer follow-up and further extensive clinical trials are needed.