导丝“鱿鱼”圈套技术辅助左锁骨下动脉原位开窗治疗近端锚定区不足的Stanford B型主动脉夹层
摘要
目的探讨近端锚定区不足的Stanford B型主动脉夹层(AD)应用导丝"鱿鱼"圈套技术辅助下左锁骨下动脉激光原位开窗主动脉腔内隔绝术治疗的效果和安全性。方法对15例近端锚定区不足(<1.5 cm)的Stanford B型AD患者,在覆膜支架腔内隔绝术基础上应用主动脉弓部导丝"鱿鱼"圈套技术辅助下左锁骨下动脉激光原位开窗术。本组病例均为非急性期夹层。结果全组患者植入国产微创或先健锥形大动脉支架15枚,左锁骨下动脉植入Fluency plus直管型覆膜支架15枚。术中开窗时间5～20 min,手术时间30～120 min。手术成功率100%,无围手术期死亡病例,无内漏及脑血管意外病例。术后CTA随访6～16个月,随访结果均显示夹层破口隔绝良好,无内漏,开窗支架通畅无狭窄。结论对近端锚定区不足的Stanford B型主动脉夹层患者应用弓部导丝"鱿鱼"圈套技术辅助下,能够快速准确行左锁骨下动脉激光原位开窗治疗,从而安全有效地拓展近端锚定区距离,值得临床借鉴。
引文
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[2] Nienaber CA,Kischer S,Rousseau H,et al.Endovascular repair of type B aortic dissection:long-term results of randomized investigation of stent grafts in aortic dissection trial[J].Cire cardiovasc Interv,2013,6(4):407-416.
[3] Kaneko T,Davidson MJ.Use of the hybrid operating loom in cardiovascular medicine[J]. Circulation,2014,130(11):910-917.
[4] Liu HY,Meng WX,Sun B,et al.The treatment strategy for acute Stanford type A aortic dissection-Detailed interpretation of 2014 European Society of Cardiology(ESC) guidelines for the diagnosis and treatment of aortic diseases[J]. Chin J Thorac Cardiovasc Surg,2015,31(2):321-324.
[5] Feezor RJ,Martin TD,Hess PJ,et al.Risk factors for peri-operative stroke during thoracic endovascular aortic repairs(TEVAR)[J].J Endovasc Ther,2007,14(4):568-573.
[6] Erbel R,Aboyans V,Boileau c,et al.2014 ESc Guidelines on the diagnosis and treatment of aortic diseases:Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of也e adult.The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology(ESC)[J].Eur Heart J,2014,35(41):2873-926.
[7] 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.
[8] Patters BD,Holt PJ,Nienaber C,et al.Management of the left subcIavian artery and neurologic complications after thoracic endovascular aortic repair[J].J Vasc Surg,2014,60(6):1491-1498.
[9] Kotelis D,Geisbnsch P,Hinz U,et al.Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aortic[J].J Vasc Surg,2009,50(6):1285-1292.
[10] 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].J Vasc Surg,2009,50(5):1155-1158.
[11] 张玉京,王亮,刘江龙,等.体外支架开窗及开槽加分支支架技术在近端锚定区不足患者的胸主动脉腔内治疗中的应用[J].中华胸心血管外科杂志,2017,33(4):245-247.
[12] 朱杰昌,戴向晨,范海伦,等.体外开窗技术治疗3例急性Stanford B型夹层的初步体会[J].中华胸心血管外科杂志,2016,32(12):733-735.
[13] Xue Y,Sun L,Zheng J,et al.The chimney technique for preserving the left subclavian artery in thoracic endovascular aortic repair[J].Eur J Cardiothorac Surg,2015,47(4):623-629.
[14] Redlinger RE Jr,AhaIlchi SS,Panneton JM.In situ laser fenestra-tion during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization[J].J Vasc Surg,2013,58(5):1171-1177.
[15] 王利新,侯凯,郭大乔,等.自主研发原位开窗系统在保留弓上分支动脉中的应用[J].中华普通外科杂志,2018,33(3):188-192.
[16] 孙国义,贾森皓,刘杰,等.原位开窗重建弓部分支血管的中期疗效观察[J].中华普通外科杂志,2018,33(3):193-195.
[17] Moulakakis KG,Mylonas SN,Dalainas I,et al.The chimney-graft technique for preserving supra-aortic branches:a review[J].Ann Cardiothorac Surg,2013,2(3):339-34.
[18] 于姝婷,陈少博,刘志丽,等.应用导丝环辅助技术行主动脉夹层腔内修复原位弓顶开窗1例报道[J].血管与腔内血管外科杂志,2017,3(1):642-643.
[19] Hongo N, Miyamoto S, Shuto R, et al. “Squid-capture” modified in situ stent-graft fenestration technique for aortic arch aneurysm repair[J]. Cardiovasc Intervent Radiol, 2014, 37 (4): 1093-1098.