单分支支架治疗锚定区不足Stanford B型主动脉夹层
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摘要
目的探讨应用Castor分支型主动脉覆膜支架治疗健康锚定区不足15 mm的Stanford B型主动脉夹层(TBAD)的临床效果。方法回顾性分析解放军第九七〇医院2017年10月至2018年6月应用Castor单分支型支架治疗18例近端健康锚定区<15 mm的TBAD患者的临床资料,其中急性TBAD 17例,慢性TBAD 1例,患者均经CT血管成像(CTA)确诊。结果手术成功率100%,手术平均时间(127.8±20.1)min,均无内漏发生,围术期无脑梗死、夹层动脉瘤破裂等并发症,无死亡病例。术中2例左锁骨下动脉(LSA)分支支架释放后存在狭窄,给予球囊扩张后狭窄解除;1例术后出现左侧肱动脉穿刺点血肿,经保守治疗治愈。随访18例,平均随访时间(8±2)个月,无截瘫及死亡病例,LSA分支支架通畅率为100%,无内漏及夹层逆撕,胸主动脉段真腔直径较术前明显扩大、假腔直径较术前明显缩小(P<0.05),胸段假腔术后血栓化率高于腹主动脉。结论 Castor分支型覆膜支架治疗近端健康锚定区不足15 mm的TBAD可以有效重建LSA,操作安全精准,隔绝效果好,短期随访无内漏发生,远期疗效尚需进一步观察。
Objective To investigate the clinical effect of Castor branched stent-graft in the treatment of Stanford B aortic dissection(TBAD) with healthy landing zone less than 15 mm. Methods The clinical data of 18 patients with TBAD(proximal healthy landing zone< 15 mm) treated with Castor branched stentgraft from October 2017 to June 2018 were retrospectively analyzed, including 17 patients with acute TBAD and 1 patient with chronic TBAD. All patients were diagnosed by computed tomography angiography(CTA).Results The success rate of operation was 100%. The mean operation time was(127.8±20.1) minutes. There was no endoleak. During the perioperative period, no complications such as death, stroke and dissecting aneurysm rupture occurred. Branched stent stenosis occurred in 2 cases after branched stent implanted,and relieved by balloon dilatation. Brachial artery puncture point hematoma occurred in 1 case and recovered after conservative treatment. 18 cases(100%, 18/18) were followed up with an average of(8±2)months. No paraplegia and death occurred. The patency rate of LSA branched stent was 100%, no endoleak or retrograde dissection occurred, and the true lumen diameter was significantly increased while the false lumen diameter was significantly decreased compared with their preoperative values(P <0.05), the false lumen thrombosis rate of the thoracic aorta was higher than that of the abdominal aorta. Conclusion Castor branched stent-graft is a safe and feasible option for TBAD with healthy landing zone less than 15 mm during thoracic endovascular aortic repair.
Objective To investigate the clinical effect of Castor branched stent-graft in the treatment of Stanford B aortic dissection(TBAD) with healthy landing zone less than 15 mm. Methods The clinical data of 18 patients with TBAD(proximal healthy landing zone< 15 mm) treated with Castor branched stentgraft from October 2017 to June 2018 were retrospectively analyzed, including 17 patients with acute TBAD and 1 patient with chronic TBAD. All patients were diagnosed by computed tomography angiography(CTA).Results The success rate of operation was 100%. The mean operation time was(127.8±20.1) minutes. There was no endoleak. During the perioperative period, no complications such as death, stroke and dissecting aneurysm rupture occurred. Branched stent stenosis occurred in 2 cases after branched stent implanted,and relieved by balloon dilatation. Brachial artery puncture point hematoma occurred in 1 case and recovered after conservative treatment. 18 cases(100%, 18/18) were followed up with an average of(8±2)months. No paraplegia and death occurred. The patency rate of LSA branched stent was 100%, no endoleak or retrograde dissection occurred, and the true lumen diameter was significantly increased while the false lumen diameter was significantly decreased compared with their preoperative values(P <0.05), the false lumen thrombosis rate of the thoracic aorta was higher than that of the abdominal aorta. Conclusion Castor branched stent-graft is a safe and feasible option for TBAD with healthy landing zone less than 15 mm during thoracic endovascular aortic repair.
引文
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[16]Naguib NN,Zima B,Nour-Eldin NE,et al.Long-term changes in aortic length after thoracic endovascular aortic repair[J].J Vasc Interv Radiol,2016,27(2):181-187.
[17]Inoue K,Sato M,Iwase T,et al.Clinical endovascular placement of branched graft for type B aortic dissection[J].Jthorac Cardiovasc Surg,1996,112(4):1111-1113.
[18]景在平,俞旭华,冯家烜,等.胸主动脉病变腔内隔绝术移植物相关的问题[J/CD].中国血管外科杂志(电子版),2013,5(3):131-134.
[19]郭伟,刘峰,葛阳阳.B型主动脉夹层腔内治疗共识与争议[J].中国实用外科杂志,2017,37(12):1339-1345.
[20]马军,孙占峰,张英男,等.一体式分支支架治疗主动脉弓部疾病临床单中心初期结果[J/CD].中国血管外科杂志(电子版),2014,6(4):208-211.
[21]Patterson B,Cobb RJ,Karthikesalingam A,et al.A systematic review of aortic remodeling after endovascular repair of type Baortic dissection:methods and outcomes[J].Ann Thorac Surg,2014,97(2):588-595.
[2]Writing C,Riambau V,Bockler D,et al.Editor′s choicemanagement of descending thoracic aorta diseases:clinical practice guidelines of the European Society for Vascular Surgery(ESVS)[J].Eur J Vasc Endovasc Surg,2017,53(1):4-52.
[3]Matsumura JS,Lee WA,Mitchell RS,et al.The Society for Vascular Surgery Practice Guidelines:management of the left subclavian artery with thoracic endovascular aortic repair[J].JVasc Surg,2009,50(5):1155-1158.
[4]杨晗,胡明,黄群,等.3D打印辅助覆膜支架修复术在复杂主动脉疾病腔内治疗中的应用[J/CD].中国血管外科杂志(电子版),2018,10(1):4-9.
[5]Kotelis D,Geisbüsch P,Hinz U,et al.Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta[J].J Vasc Surg,2009,50(6):1285-1292.
[6]孙占国,蒋京军,张小明,等.TEVER术中主动脉弓部分支动脉的重建[J].中国普通外科杂志,2014,23(12):1609-1613.
[7]王利新,符伟国.主动脉夹层治疗的现况[J/CD].中国血管外科杂志(电子版),2016,8(1):1-5.
[8]Bradshaw RJ,Ahanchi SS,Powell O,et al.Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases[J].J Vasc Surg,2017,65(5):1270-1279.
[9]Wilson A,Zhou S,Bachoo P,et al.Systematic review of chimney and periscope grafts for endovascular aneurysm repair[J].Br J Surg,2013,100(12):1557-1564.
[10]Waterford SD,Chou D,Bombien R,et al.Left subclavian arterial coverage and stroke during thoracic aortic endografting:a systematic review[J].Ann Thorac Surg,2016,101(1):381-389.
[11]Rizvi AZ,Murad MH,Fairman RM,et al.The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions:a systematic review and meta-analysis[J].J Vasc Surg,2009,50(5):1159-1169.
[12]Mangialardi N,Serrao E,Kasemi H,et al.Chimney technique for aortic arch pathologies:an 11-year single-center experience[J].J Endovasc Ther,2014,21(2):312-323.
[13]Tse LW,Lindsay TF,Roche-Nagle G,et al.Radiofrequency in situ fenestration for aortic arch vessels during thoracic endovascular repair[J].J Endovasc Ther,2015,22(1):116-121.
[14]Malina M,Sonesson B.In situ fenestration:a novel option for endovascular aortic arch repair[J].J Cardiovasc Surg(Torino),2015,56(3):355-362.
[15]朱水波,朱健,郗二平,等.不开胸“杂交”手术治疗主动脉弓部夹层的近中期随访研究[J].中国胸心血管外科临床杂志,2016,23(10):988-991.
[16]Naguib NN,Zima B,Nour-Eldin NE,et al.Long-term changes in aortic length after thoracic endovascular aortic repair[J].J Vasc Interv Radiol,2016,27(2):181-187.
[17]Inoue K,Sato M,Iwase T,et al.Clinical endovascular placement of branched graft for type B aortic dissection[J].Jthorac Cardiovasc Surg,1996,112(4):1111-1113.
[18]景在平,俞旭华,冯家烜,等.胸主动脉病变腔内隔绝术移植物相关的问题[J/CD].中国血管外科杂志(电子版),2013,5(3):131-134.
[19]郭伟,刘峰,葛阳阳.B型主动脉夹层腔内治疗共识与争议[J].中国实用外科杂志,2017,37(12):1339-1345.
[20]马军,孙占峰,张英男,等.一体式分支支架治疗主动脉弓部疾病临床单中心初期结果[J/CD].中国血管外科杂志(电子版),2014,6(4):208-211.
[21]Patterson B,Cobb RJ,Karthikesalingam A,et al.A systematic review of aortic remodeling after endovascular repair of type Baortic dissection:methods and outcomes[J].Ann Thorac Surg,2014,97(2):588-595.