21例锁骨下动脉瘤(SAA)腔内诊治经验

 目的  总结锁骨下动脉瘤(subclavicular artery aneurysm, SAA)患者腔内治疗的效果。方法  复旦大学附属中山医院血管外科2013年1月至2016年 6月共诊治SAA患者21例,男11例,女10例,平均年龄(39±9)岁。所有SAA患者均行腔内治疗,回顾分析围手术期和术后效果及不良事件。结果  技术成功率为100%。术中1例SAA患者支架植入后,近端Ⅰ型内漏明显,改行平行支架植入术;2例Ⅱ型内漏和2例SAA瘤腔巨大分别行侧支和瘤腔钢圈栓塞;中位随访时间19(6～42)个月。随访期间3例SAA患者发生支架内狭窄,1例右SAA患者在释放支架时未覆盖锁骨下动脉开口,在第2年出现支架近端严重狭窄;2例患者SAA位于锁骨下动脉第3段,左右各1例,分别在第2年和第3年出现支架远端严重狭窄。患者2年和3年支架通畅率分别为90.5%和85.7%。结论  腔内治疗SAA操作简单,效果明确;右SAA治疗中应在右锁骨下动脉和右颈总动脉分叉处的切线位角度,使分叉部位完全展开,尽量覆盖开口;对于短瘤颈平行支架植入效果较好;锁骨下动脉瘤位于第3段时,术后易出现支架内狭窄,要注意远期随访。

The endovascular treatment of 21 cases of suclavian artery aneurysms (SAA)

Objective  To evaluate endovascular treatment of subclavian artery aneurysm (SAA) retrospectively. Methods  Between Jan., 2013 and Jun., 2016, 21 cases of SAA (11 males and 10 females) were admitted in the Department of Vascular Surgery, Zhongshan Hospital, Fudan University, with the average age of (39±9) years. All patientes underwent endovascular treatment. We analyzed the perioperative and postoperative effect and adverse events retrospectively. Results  The technique successful rate of endovascular repair was 100%. One case of SAA patient occurred proximal type Ⅰ endoleak after stent implantation, then unerdwent parallel stent implantation and 2 cases of SAA patients appeared type Ⅱ endoleak, and 2 cases of SAA patients of a huge tumor cavity underwent line of collateral and tumor cavity embolization respectively. The mean follow-up was 19 (6-42) months. During the follow-up, 3 cases of SAA patients appeared in-stent stenosis, 1 case had not covered the subclavian artery opening position, 3 patients appeard stent stenosis; 2 cases located in the third paragraph of subclavian artery (1 case around each) appeared in-stent stenosis in 2 years and 3 years, respectively. The 2-year and 3-year stent patency rate were 90.5% and 85.7%. Conclusions  Endovascular treatment of SAA is effective and easy to implement. In the endovascular treatment of SAA, we need to make the fork parts fully extended in the right subclavian artery and right common carotid artery bifurcation of tangent angle, and cover the subclavian artery opening position. The subclavian artery aneurysms located in the third paragraph are easy to appear stent stenosis. We should pay attention to the long-term follow-up.