主动脉根部-升主动脉段病变腔内修复的研究进展

主动脉根部-升主动脉段,由于其复杂的解剖结构及血流动力学湍流特点,使得在设计腔内移植物时,需考虑“主动脉瓣膜、双侧冠脉开口、主动脉窦部膨大、头臂干开口”等几个因素。因而被视为腔内修复最后的“禁区”,至今仍然无理想的腔内移植物能够用于此段病变的治疗,成为全球各大血管外科中心聚焦的前沿问题。现有研究方案包括Endo-Bentall法、Endo-Wheat法以及“景氏瓣窗型”移植物腔内修复动物实验等,但是主要存在个体化局限性、冠脉支架的远期通畅率不明确和移植物感染等悬而未解问题。目前尚无完善的腔内移植物或腔内手术方案可解决主动脉根部-升主动脉段病变。鉴于目前此技术的局限性和有限的临床经验,这项技术应保留给高危患者,特别是那些拒绝开放干预的患者。笔者对目前现有的腔内修复累及主动脉根部及升主动脉病变方案做一综述。

Progress of endovascular repair of lesions involving aortic root/ascending segment

Aortic root/ascending segment, due to its complex anatomical structure and hemodynamic turbulence characteristics, requires consideration of several factors such as "aortic valve, bilateral coronary artery openings, aortic sinus dilation, and innominate artery opening" when designing endovascular grafts. Therefore, it is regarded as the final "forbidden zone" for endovascular repair, and to this day, there is still no ideal intraluminal graft available for treating lesions in this segment, becoming a forefront issue focused on by major vascular surgery centers worldwide. Current research strategies include the Endo-Bentall procedure, Endo-Wheat procedure, and "Jing''s valved-fenestrated endografting" animal experiments, but significant challenges remain unresolved, such as individualization limitations, unclear long-term patency of coronary stents, and graft infections. Currently, there are no perfect endografts or endovascular surgical approaches to address lesions in the aortic root-ascending aorta segment. Given the limitations of the current technology and limited clinical experience, this technique should be reserved for high-risk patients, especially those who refuse open interventions. Here, the authors provide an overview of the currently available endovascular repair options involving the aortic root and ascending aorta lesions.