腔内隔绝术联合开窗技术治疗累及主动脉弓部的Stanford B型夹层动脉瘤的临床研究

目的 总结腔内隔绝术联合开窗技术治疗累及主动脉弓部的Stanford B型夹层动脉瘤的可行性和手术效果.方法 采用腔内隔绝术联合开窗技术治疗10例累及主动脉弓部的Stanford B型夹层动脉瘤.腔内隔绝术联合开窗技术封堵夹层破口,保留主动脉弓全部分支8例,保留头臂干及颈总动脉2例.手术均在局部麻醉下完成,覆膜支架开窗在术中进行.结果 患者术中造影无内漏,术后无死亡,2例左锁骨下动脉封堵的患者未出现神经系统并发症.随访中,开窗支架通畅,无移位,保留的主动脉弓分支动脉通畅,降主动脉真腔扩大,假腔血栓化并缩小.结论 对于累及主动脉弓部的Stanford B型夹层动脉瘤,腔内隔绝术联合开窗技术治疗是安全有效的治疗方法.

Endovascular aortic repair combined with fenestrated stent-grafts techniques for the treatment of Stanford type B aortic dissection involving aortic arch

Objective To discuss the feasibility and operation effects of endovascular aortic repair combined with fenestrated stent-grafts techniques in the treatment of Stanford type B aortic dissecting aneurysm involving aortic arch.Methods A total of 10 cases of Stanford type B aortic dissecting aneurysm involving aortic arch were treated by endovascular aortic repair combined with fenestrated stent-grafts techniques for aneurysm closure,including 8 cases preserving aortic arch branches and 2 cases preserving brachiocephalic trunk and left common carotid artery.All operation were performed under localized anesthesia,and the fenestration were made during operation.Results All patients survived without endoleak.No neurological complications happened in the two patients whose left subclavian artery were occluded.During the follow-up period,blood flow in all the stent-grafts and aortic arch branches were fluent and no shift occurred.In the descending aorta,the diameter of true lumen increased.False lumen was thrombosed and the diameter decreased.Conclusion Endovascular aortic repair combined with fenestrated stent-grafts techniques is a safe and effective method in the treatment of Stanford type B aortic dissecting aneurysm involving aortic arch.