头臂血管转流并主动脉覆膜支架植入术在Stanford B1C型主动脉夹层中的应用
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摘要
目的评价头臂血管转流并主动脉覆膜支架植入术治疗Stanford B1C型主动脉夹层的治疗效果。方法 2013年12月至2017年12月期间我中心应用头臂血管转流并同期行覆膜支架植入手术技术治疗Stanford B1C型主动脉夹层患者49例,其中男33例、女16例,平均年龄(60.4±5.5)岁。29例行左颈总动脉-左锁骨下动脉人工血管转流术,18例行右颈总动脉-左颈总动脉-左锁骨下动脉人工血管转流术,2例行右颈总动脉-右锁骨下动脉转流+左颈总动脉-左锁骨下动脉人工血管转流术。结果全组患者术后30 d内死亡1例(2.0%),术后生存48例,随访率100.0%(48/48),术后随访6～47(26.8±11.9)个月,其中1例术后6个月再发胸痛,急诊复查全程主动脉血管造影CT提示逆撕Stanford A1S型夹层,行外科手术,效果满意。全组存活患者未发生内漏。结论头臂血管转流并同期行主动脉覆膜支架植入手术治疗Stanford B1C型主动脉夹层患者是安全有效的。
Objective To evaluate the results of a hybrid procedure for treating Stanford type B1C aortic dissection.Methods In our center, 49 patients with Stanford type B1C aortic dissection underwent supra-arch branch vessel bypass and thoracic endovascular aortic repair(TEVAR) from December 2013 to December 2017. There were 33 males and 16 females with an average age of 60.4±5.5 years. Left common carotid artery to left subclavian artery bypass(n=29), right common carotid artery to left common carotid artery and left subclavian artery bypass(n=18), left common carotid artery to left subclavian artery and right common carotid artery to right subclavian artery bypass(n=2) were performed.Results Early mortality rate was 2.0%(1/49). Forty-eight patients survived postoperatively. The follow-up rate was100.0%(48/48). The patients were followed up for 6 to 47(26.8±11.9) months postoperatively. Chest pain relapsed in one patient 8 months after the operation. The whole aorta CTA showed type A1S aortic dissection in one patient 6 months after the operation, and the re-operation was satisfactory. There was no endoleak or paraplegia. Conclusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for type B1C aortic dissection.
Objective To evaluate the results of a hybrid procedure for treating Stanford type B1C aortic dissection.Methods In our center, 49 patients with Stanford type B1C aortic dissection underwent supra-arch branch vessel bypass and thoracic endovascular aortic repair(TEVAR) from December 2013 to December 2017. There were 33 males and 16 females with an average age of 60.4±5.5 years. Left common carotid artery to left subclavian artery bypass(n=29), right common carotid artery to left common carotid artery and left subclavian artery bypass(n=18), left common carotid artery to left subclavian artery and right common carotid artery to right subclavian artery bypass(n=2) were performed.Results Early mortality rate was 2.0%(1/49). Forty-eight patients survived postoperatively. The follow-up rate was100.0%(48/48). The patients were followed up for 6 to 47(26.8±11.9) months postoperatively. Chest pain relapsed in one patient 8 months after the operation. The whole aorta CTA showed type A1S aortic dissection in one patient 6 months after the operation, and the re-operation was satisfactory. There was no endoleak or paraplegia. Conclusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for type B1C aortic dissection.
引文
1饶从亮,胡何节,王晓天,等.亚急性期Stanford B型主动脉夹层腔内隔绝术后主动脉重塑的特点及影响因素.中国普通外科杂志,2017, 26(12):1547-1554.
2 Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting:roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther, 2002,9(Suppl 2):198-1105.
3冯俊波,葛圣林,周汝元,等“一站式”杂交手术及单纯腔内隔绝术治疗Stanford B型主动脉夹层.安徽医学,2015, 36(4):476-478.
4 Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching andendovascular stent graft repair. Eur J Vasc Endovasc Surg, 2010,39(6):683-690.
5范海伦,汤凯丰,胡凡果,等.体外开窗TEVAR技术治疗不良近端锚定区Stanford B型主动脉夹层的近期疗效分析.血管与腔内血管外科杂志,2016, 2(5):415-419.
6舒畅,王暾.“烟囱”技术治疗累及弓部分支动脉病变中远期疗效研究.中国实用外科杂志,2014, 34(12):1163-1166.
7 Yuri K, Yokoi Y, Yamaguchi A, et al. Usefulness of fenestrated stent grafts for thoracic aortic aneurysms. Eur J Cardiothorac Surg,2013,44(4):760-767.
8 Appoo JJ, Tse LW, Pozeg ZI, et al. Thoracic aortic frontier:review of current applications and directions of thoracic endovascular aortic repair(TEVAR). Can J Cardiol, 2014, 30(1):52-63.
9 Milewski RK, Szeto WY, Pochettino A, et al. Have hybrid procedures replaced open aortic arch reconstruction in high-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction. J Thorac Cardiovasc Surg, 2010,140(3):590-597.
10 Sood V, Patel HJ, Williams DM, et al. Open and endovascular repair of the nontraumatic isolated aortic arch aneurysm. J Vasc Surg, 2014, 60(1):57-63.
11 Bavaria J, Vallabhajosyula P, Moeller P, et al. Hybrid approaches in the treatment of aortic arch aneurysms:postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013,145(3 Suppl):S85-S90.
12 Ozsvath KJ, Roddy SP, Darling RC 3rd, et al. Carotid-carotid crossover bypass:is it a durable procedure? J Vasc Surg, 2003,37(3):582-585.
13魏以桢,常谦,于存涛,等.一期杂交手术治疗累及主动脉弓远端交病的降主动脉.中国胸心血管外科临床杂志,2011,18(2):99-103.
14 Grabenwoger M, Alfonso F, Bachet J, et al. Thoracic Endovascular Aortic Repair(TEVAR)for the treatment of aortic diseases:a position statement from the European Association for CardioThoracic Surgery(EACTS)and the European Society of Cardiology(ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions(EAPCI). Eur J Cardiothorac Surg, 2012, 42(1):17-24.
15 Pepper J. Differential aspects of the disease and treatment of Thoracic Acute Aortic Dissection(TAAD)-the European experience. Ann Cardiothorac Surg, 2016, 5(4):360-367.
16 Preventza O, Coselli JS. Differential aspects of ascending thoracic aortic dissection and its treatment:the North American experience.Ann Cardiothorac Surg, 2016, 5(4):352-359.
17 Dijkstra ML, Vainas T, Zeebregts CJ, et al. Editor s choice-spinal cord ischaemia in endovascular thoracic and thoraco-abdominal aortic repair:review of preventive strategies. Eur J Vasc Endovasc Surg, 2018, 55(6):829-841.
18 Bozso SJ, White A, Nagendran J, et al. Hybrid aortic arch and frozen elephant trunk reconstruction:bridging the gap between conventional and total endovascular arch repair. Expert Rev Cardiovasc Ther, 2018,16(3):209-217.
19 Ullery BW, Cheung AT, Fairman RM, et al. Risk factors, outcomes,and clinical manifestations of spinal cord ischemia following thoracic endovascular aortic repair. J Vasc Surg, 2011, 54(3):677-684.
20 Jayia P, Constantinou J, Hamilton H, et al. Temporary perfusion branches to decrease spinal cord ischemia in the endovascular treatment of thoraco-abdominal aortic aneurysms:based on a presentation at the 2013 VEITH Symposium, November 19-23,2013(New York, NY, USA). Aorta(Stamford), 2015, 3(2):56-60.
2 Mitchell RS, Ishimaru S, Ehrlich MP, et al. First International Summit on Thoracic Aortic Endografting:roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther, 2002,9(Suppl 2):198-1105.
3冯俊波,葛圣林,周汝元,等“一站式”杂交手术及单纯腔内隔绝术治疗Stanford B型主动脉夹层.安徽医学,2015, 36(4):476-478.
4 Antoniou GA, El Sakka K, Hamady M, et al. Hybrid treatment of complex aortic arch disease with supra-aortic debranching andendovascular stent graft repair. Eur J Vasc Endovasc Surg, 2010,39(6):683-690.
5范海伦,汤凯丰,胡凡果,等.体外开窗TEVAR技术治疗不良近端锚定区Stanford B型主动脉夹层的近期疗效分析.血管与腔内血管外科杂志,2016, 2(5):415-419.
6舒畅,王暾.“烟囱”技术治疗累及弓部分支动脉病变中远期疗效研究.中国实用外科杂志,2014, 34(12):1163-1166.
7 Yuri K, Yokoi Y, Yamaguchi A, et al. Usefulness of fenestrated stent grafts for thoracic aortic aneurysms. Eur J Cardiothorac Surg,2013,44(4):760-767.
8 Appoo JJ, Tse LW, Pozeg ZI, et al. Thoracic aortic frontier:review of current applications and directions of thoracic endovascular aortic repair(TEVAR). Can J Cardiol, 2014, 30(1):52-63.
9 Milewski RK, Szeto WY, Pochettino A, et al. Have hybrid procedures replaced open aortic arch reconstruction in high-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction. J Thorac Cardiovasc Surg, 2010,140(3):590-597.
10 Sood V, Patel HJ, Williams DM, et al. Open and endovascular repair of the nontraumatic isolated aortic arch aneurysm. J Vasc Surg, 2014, 60(1):57-63.
11 Bavaria J, Vallabhajosyula P, Moeller P, et al. Hybrid approaches in the treatment of aortic arch aneurysms:postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013,145(3 Suppl):S85-S90.
12 Ozsvath KJ, Roddy SP, Darling RC 3rd, et al. Carotid-carotid crossover bypass:is it a durable procedure? J Vasc Surg, 2003,37(3):582-585.
13魏以桢,常谦,于存涛,等.一期杂交手术治疗累及主动脉弓远端交病的降主动脉.中国胸心血管外科临床杂志,2011,18(2):99-103.
14 Grabenwoger M, Alfonso F, Bachet J, et al. Thoracic Endovascular Aortic Repair(TEVAR)for the treatment of aortic diseases:a position statement from the European Association for CardioThoracic Surgery(EACTS)and the European Society of Cardiology(ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions(EAPCI). Eur J Cardiothorac Surg, 2012, 42(1):17-24.
15 Pepper J. Differential aspects of the disease and treatment of Thoracic Acute Aortic Dissection(TAAD)-the European experience. Ann Cardiothorac Surg, 2016, 5(4):360-367.
16 Preventza O, Coselli JS. Differential aspects of ascending thoracic aortic dissection and its treatment:the North American experience.Ann Cardiothorac Surg, 2016, 5(4):352-359.
17 Dijkstra ML, Vainas T, Zeebregts CJ, et al. Editor s choice-spinal cord ischaemia in endovascular thoracic and thoraco-abdominal aortic repair:review of preventive strategies. Eur J Vasc Endovasc Surg, 2018, 55(6):829-841.
18 Bozso SJ, White A, Nagendran J, et al. Hybrid aortic arch and frozen elephant trunk reconstruction:bridging the gap between conventional and total endovascular arch repair. Expert Rev Cardiovasc Ther, 2018,16(3):209-217.
19 Ullery BW, Cheung AT, Fairman RM, et al. Risk factors, outcomes,and clinical manifestations of spinal cord ischemia following thoracic endovascular aortic repair. J Vasc Surg, 2011, 54(3):677-684.
20 Jayia P, Constantinou J, Hamilton H, et al. Temporary perfusion branches to decrease spinal cord ischemia in the endovascular treatment of thoraco-abdominal aortic aneurysms:based on a presentation at the 2013 VEITH Symposium, November 19-23,2013(New York, NY, USA). Aorta(Stamford), 2015, 3(2):56-60.