累及主动脉弓的Stanford B型主动脉夹层的腔内治疗

摘要

ObjectiveTo evaluate the advantages and disadvantages of various endovascular repair methods for the treatment of Stanford type B aortic dissection involving distal aortic arch.MethodsThe clinical data of 42 patients with Stanford type B aortic dissection involving distal aortic arch from January 2005 to December 2015 in Provincial Hospital Affiliated to Anhui Medical University was analyzed retrospectively. All the patients were treated with endovascular repair. According to the morphology of aortic dissection, the following methods were used: directly coverage the oriifce of left subclavian artery (LSA), chimney technique, fenestrated grafts, neck vascular bypass surgery. ResultsIn 42 patients, 32 cases received LSA coverage, among which 3 cases with typeⅠ endoleak, 6 cases with type Ⅱ endoleak, 2 cases were improved through left subclavian artery embolism. After surgery, 1 case with lower limbs paraplegia, 1 case with steal blood syndrome, 2 cases with upper limb ischemia. After conservative treatment, the above symptoms were all improved. Chimney technique was performed in 4 cases, among which 2 cases occured endoleak. Fenestration technique was performed in 4 cases. Left common carotid artery and subclavian artery were reconstructed in 2 cases through neck vascular bypass surgery. No perioperative death occurred. After long-term follow-up, all the brachial stent-grafts were patent. Most endoleak were disappeared gradually, endoleak still existed in 3 cases with no change of aneurysm diameter.ConclusionsEndovascular treatment is a safe and effective method for Stanford type B aortic dissection involving distal aortic arch, in the meantime, strict preoperative evaluation and suitable operation method are also important.%目的：探讨累及主动脉弓部的Stanford B型主动脉夹层的各种腔内治疗方法的优缺点。方法回顾性分析2005年1月至2015年12月安徽医科大学附属省立医院收治的42例累及主动脉弓的Stanford B型主动脉夹层的临床资料。所有患者均经腔内治疗，根据夹层形态不同，分别应用腔内直接封堵左锁骨下动脉（left subclavian artery，LSA）、“烟囱”技术、移植物开槽、颈部血管旁路手术重建主动脉弓部分支血管。结果42例患者中，腔内直接封堵LSA32例，发生Ⅰ型内漏3例，Ⅱ型内漏6例，2例通过LSA栓塞好转。术后出现1例下肢截瘫，1例盗血综合征，2例上肢缺血，均行保守治疗后好转。4例通过“烟囱”技术重建LSA，2例发生Ⅰ型内漏。4例通过“开窗”技术保留LSA。2例通过颈部血管旁路重建左颈总动脉及锁骨下动脉。围手术期无死亡病例。中长期随访中，所有分支动脉支架均保持通畅，大部分内漏逐渐消失，3例术后持续存在内漏，但瘤体直径无变化。结论对累及主动脉弓部的Stanford B型主动脉夹层，在严格做好术前评估、选择合适术式的情况下，腔内治疗是安全有效的。