“单向”导丝技术结合新型Castor分支支架植入在Stanford B型主动脉夹层患者胸主动脉腔内修复术中的应用效果及体会

背景胸主动脉腔内修复(TEVAR)术是目前临床治疗Stanford B型主动脉夹层的标准术式,术中重建左锁骨下动脉非常必要,如何快速有效地重建左锁骨下动脉、避免内漏发生是支架研发的难点,而国产新型Castor分支支架有效解决了这一问题。目的探讨“单向”导丝技术结合新型Castor分支支架植入在Stanford B型主动脉夹层患者TEVAR术中的应用效果及体会。方法回顾性分析2018年8月—2019年8月桂林医学院第二附属医院、桂林医学院第一附属医院及桂林市人民医院收治的行“单向”导丝技术结合新型Castor分支支架植入治疗的Stanford B型主动脉夹层患者58例,患者夹层破口距离左锁骨下动脉的距离均≤15 mm。记录患者手术情况、并发症情况及预后,并比较患者术前及术后3个月胸主动脉、腹主动脉的真、假腔直径。结果患者手术成功率为98.3%(57/58),术中出现内漏2例,经隔绝瘤腔完全血栓化治疗而达到治愈;急性心肌梗死1例,抢救成功;左锁骨下动脉起始端闭塞1例。患者术后3个月胸主动脉真腔直径较术前扩大,假腔直径较术前缩小(P<0.05);患者术后3个月腹主动脉真、假腔直径与术前比较,差异无统计学意义(P>0.05)。结论“单向”导丝技术结合国产新型Castor分支支架植入治疗近端锚定区不足15 mm的Stanford B型主动脉夹层效果满意,术中重建左锁骨下动脉血运效果较好,并发症较少。

Application Effect and Experience of'Unidirectional'Guide Wire Technique Combined with New Castor Branch Stent Implantation in Thoracic Endovascular Aortic Repair Surgery for Patients with Stanford Type B Aortic Dissection

Backgroud At present,thoracic endovascular aortic repair(TEVAR)surgery is the standard operation for the clinical treatment of Stanford type B aortic dissection,and intraoperative reconstruction of the left subclavian artery is very necessary,but how to quickly and effectively reconstruct the left subclavian artery and avoid the occurrence of endoleak is a difficult point in the research and development of stents,and the domestic new Castor branch stent effectively solves this problem.Objective To explore the application effect and experience of"unidirectional"guide wire technique combined with new Castor branch stent implantation in TEVAR surgery for patients with Stanford type B aortic dissection.Methods From August 2018 to August 2019,a total of 58 patients with Stanford type B aortic dissection who were treated by"unidirectional"guide wire technique combined with new Castor branch stent implantation in the Second Affiliated Hospital of Guilin Medical University,Affiliated Hospital of Guilin Medical University and Guilin People's Hospital were selected retrospectively,and the distance from the dissection rupture to the left subclavian artery was less than 15 mm in all patients.The operation,complications and prognosis of patients were recorded,and the diameter of true and false lumen of aorta and abdominal aorta before operation and 3 months after operation were compared.Results The success rate of the operation was 98.3%(57/58).Two cases of endoleak occurred during the operation,which were cured by complete thrombotic treatment in isolated tumor cavity;1 case of acute myocardial infarction was successfully rescued;1 case occurred occlusion of the initial end of left subclavian artery.Three months after operation,the diameter of aortic true lumen was larger than that before operation,and the diameter of aortic false lumen was smaller than that before operation(P<0.05);and there was no statistically significant difference in the diameters of the true and false lumen of the abdominal aorta at 3 months after operation compared with that before operation(P>0.05).Conclusion"Unidirectional"guide wire technique combined with domestic new Castor branch stent implantation for the treatment of Stanford type B aortic dissection patients with landing zone less than 15 mm is satisfactory,intraoperative reconstruction of the left subclavian artery has better blood flow and the complications were less.