体外开窗及开槽技术在主动脉弓部疾病TEVAR术的应用

目的：探讨体外开窗及开槽技术应用于胸主动脉腔内修复术（TEVAR）治疗主动脉弓部疾病的可行性。方法：回顾性分析2016年9月—2019年4月23例体外开窗及开槽技术联合TEVAR术治疗主动脉弓部疾病患者的临床资料。结果：23例患者中，覆膜支架近端放置Z0区3例，Z1区6例，Z2区14例。重建40条分支血管，包括无名动脉3条，左颈总动脉9条，左锁骨下动脉23条，迷走左椎动脉3条，迷走右锁骨下动脉2条；开槽技术重建15条，开窗技术25条。9条左锁骨下动脉被遮盖，技术成功率77.5%。31条分支血管术后通畅，随访中1条分支血管血栓形成，6条失访。4例（17.4%）内漏，2例随访中消失，1例减少。围手术期2例缺血性脑卒中（8.7%），1例死亡（4.3%），无截瘫发生。结论：主动脉弓部疾病TEVAR治疗中应用体外开窗及开槽技术是可行、有效的方法。

Application of in-vitro fenestration and scallop techniques in TEVAR for aortic arch disease

Objective: To investigate the feasibility of using in vitro fenestration and scallop in thoracic aortic endovascular repair (TEVAR) for the treatment of aortic arch disease.Methods: The clinical data 23 patients undergoing TEVAR with in-vitro fenestration and scallop for aortic arch diseases between September 2016 and April 2019 were retrospectively analyzed.Results: In the 23 patients, the covered stent graft was deployed at proximal landing zone 0 in 3 case, at zone 1 in 6 cases, and at zone 2 in 14 cases respectively. A total of 40 branch vessels were revascularized, including 3 innominate arteries, 9 left common carotid arteries, 23 left subclavian arteries, 3 aberrant left vertebral arteries and 2 aberrant right subclavian arteries, and of them, 15 cases were reconstructed by scallop and 25 cases by fenestration. The origins of 9 left subclavian arteries were covered, and the technical success rate was 77.5%. Thirty-one branch vessels were patent after operation, one of them developed thrombosis during follow-up and 6 of them were lost to follow-up. Endoleak occurred in 4 patients (17.4%), which disappeared in 2 cases and lessened in one case during follow-up. During the perioperative period, ischemic stroke occurred in 2 patients and death in one patient, but no case of paralysis occurred. Conclusion: Using in-vitro fenestration and scallop techniques in TEVAR are feasible and effective methods for the treatment of aortic arch disease.