目的:总结复杂型StanfordB型主动脉夹层中左锁骨下动脉重建的经验和方法.方法:2010年4月至2016年5月,共有43例复杂型StanfordB型主动脉夹层采用腔内修复术治疗,并均重建左锁骨下动脉,其中右腋动脉-左腋动脉人工血管旁路18例,开窗技术14例,烟囱技术11例.结果:均成功手术,无术中死亡,术后造影显示支架敷贴良好,定位准确,左锁骨下动脉血流通畅.术后无头晕症状,双上肢血压差均在15 mmHg之内.1例术后5天并发逆行性A型夹层猝死.肾功能衰竭2例,行透析治疗后治愈.随访38例,失访4例,随访时间2～33月(17.0士5.2月),1例患者术后45天猝死;术后3月、1年复查主动脉CTA均示支架无移位.1例Ⅰ型内漏,术后8月复查CTA示内漏消失;1例术后9月人工血管内血栓形成,中段狭窄约40％;2例并发支架远端动脉瘤形成.结论:腋动脉人工血管旁路术、开窗技术、烟囱技术进行左锁骨下动脉重建,联合主动脉腔内修复术治疗复杂型StandfordB型主动脉夹层,可以取得满意的临床效果.%Objective:To summarize our experience and methods of analysis the mode of reconstruct left clavicle artery of endovascular aortic repair for complicated Stanford B type aortic dissection.Methods:The clinical data of 43 patients with complicated Stanford B type aortic dissection underwent endovascular aortic repair and all of cases reconstructed left clavicle artery.The methods of reconstructed left clavicle artery for the patients including 18 cases received right axillary-left axillary PTFE graft bypass,14 cases received in situ laser fenestration,and 1 lcases underwent "Chimney" stenting technology.Results:All the 43 patients were successfully operated,whose stents were successfully released,and the left clavicle which had blood flow patency.All stents received the treatment without suffering dizzy spells,and their blood pressure difference within 15 mmHg between the upper extremities.One case suffered sudden death after 5 days because of retrogression of type A aortic dissection.Two cases had renal failure who were cured by hemodialysis.Thirty-eight cases were followed up at 3 months to 33 months.One case suffered sudden death after 45 days.After 1 years,the patients received aortic CTA,which were showed all of the intravascular stent without shift.One patient with type Ⅰ endoleak was restored within 8 months,which was showed by aortic CTA.One case with artery stenosis in the the middle of artificial blood vessel after 9 months,which within 40％.Two patients occurred aneurysms at the distal end of the stent.Conclusions:The method of reconstructed left clavicle artery (Axillary-axillary bypass grafting,in situ laser fenestration and "Chimney" stenting techology) which associate with endovascular repair treatment is a satisfactory way for complicated Stanford B type aortic dissection.
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