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.

Endovascular repair combined with assistant techniques for the treatment of Stanford Type B aortic dissection involving aortic arch

Objective To evaluate endovascular repair combined with assistant techniques for the treatment of Stanford type B aortic dissection involving aortic arch.Method From July 2002 to June 2010,46 patients of aortic arch dissection with the primary entry tear next to the orifice of left subclavian artery,were treated with endovascular repair.Left subclavian arteries were covered with TEVAR in 43 cases.PDA occludes were used in 6 patients.Nine patients received extrathoracic supra-aortic branches bypass.Double-barrel technique was performed in 8 patients.Fenestrated stent graft was used in 1 patient.Result All patients survived and were followed up for 2 to 76 months.No severe neurological complications happened.All synthetic grafts and carotid artery stents were patent.Type Ⅱ endoleak occurred in 10 patients,among them 6 received PDA occlude implantation in the left subclavian artery,and 2 patients recovered by conservative treatment.Nine patients suffered from ischemia of the left upper extremity,and 8 of them were treated with conservative method,one received bilateral subclavian artery bypass because of severe ischemia after endovascular treatment.In follow-up,all of the stent-grafts and grafts were patent.In the descending aorta,the diameter of true lumen increased significantly and the diameter of false lumen shrank gradually.Conclusions Endovascular aortic repair combined with extrathoracic supra-aortic branches bypass,PDA occlude,double-barrel technique and fenestrated technique is a safe and effective method for Stanford Type B aortic dissection involving aortic arch.