国产覆膜支架预开窗保留左锁骨下动脉在近端锚定区不足的B型主动脉夹层TEVAR中的应用

摘要

Objective To explore the preliminary results of application of reserving the left subclavian artery by fenestration of domestic stent graft in the thoracic endovascular aortic repair (TEVAR) of type B dissection with unfavourable proximal landing zone.Methods From October 2015 to January 2018,a total of 13 patients with type B aortic dissection without healthy proximal landing zones underwent TEVAR using fenestration of domestic stent graft in our hospital.Computed tomography angiography (CTA) data were measured before surgery.Digital subtraction angiography (DSA) was conducted after surgery.All patients underwent CTA or ultrasound examination during follow-up.Operation success rate,survive rate,patency of left subclavian artery and complications were analyzed.Results All the patients were deployed fenestrated endografts successfully.No proximal endoleak happened during perioperative period.Delirium occurred in 1 case during 7 postoperative days and fully recovered with the medical treatment.The mean follow-up period was (9.8 ± 9.5) months (range,1-29 months).11 patients underwent CTA and 2 patients underwent ultrasound examination during follow-up.During period of following up,no patients died,no proximal endoleak appeared,and all the left subclavian arteries reserving by fenestration.Conclusions Reserving the left subclavian artery by fenestration of domestic stent graft in TEVAR of type B dissection with hostile proximal sealing zone is economical,safe and feasible,which expand the indication of TEVAR for aortic dissection,and the long-term outcomes of this technique need to be assessed in the future.%目的 探讨国产覆膜支架预开窗保留左锁骨下动脉治疗近端锚定区不足的Stanford B型主动脉夹层的初步研究结果.方法 回顾性分析山东大学附属省立医院2015年10月至2018年1月13例应用国产覆膜支架预开窗技术治疗的近端锚定区不足的B型主动脉夹层患者的临床资料.所有患者均术前测量计算机断层扫描血管成像(CTA)数据,台上国产覆膜支架预开窗后行胸主动脉腔内修复术(TEVAR).观察术后数字减影血管造影(DSA)结果.所有患者随访期间均进行了CTA或超声检查.以手术的成功率、存活率及左锁骨下动脉通畅率为有效性观察指标,并统计相应的并发症.结果 13例患者支架释放全部成功.无围手术期近端内漏发生,1例患者术后发生了谵妄,经内科治疗后完全恢复.13例患者随访时间1～29(9.8±9.5)个月.11例患者术后复查CTA、2例患者术后复查超声,随访期13例患者无死亡,无近端内漏,无左锁骨下动脉闭塞.结论 国产覆膜支架预开窗技术的初步研究证实这一技术治疗近端锚定区不足的Stanford B型主动脉夹层经济安全可行,拓展了TEVAR适应证,远期结果还需要进一步评估.