“烟囱”技术在胸主动脉病变中的应用

The application of chimney technique in thoracic endovascular aortic repair of thoracic aortic lesion

目的探讨"烟囱"技术在缺乏锚定区的胸主动脉病变中应用的可行性和价值。方法对2011年1月至2011年6月我科用"烟囱"技术治疗5例DebakeyⅢ型主动脉夹层和1例Debakey Ⅲ型胸主动脉穿透性溃疡患者的临床资料进行回顾性分析,探讨"烟囱"技术的适应证和实施要点。结果 6例患者在植入主动脉支架人造血管的同时分别植入"烟囱"支架于左锁骨下动脉3例,左颈总动脉3例。手术均获得成功,支架植入后数字减影血管造影显示病变完全隔绝,"烟囱"植入分支通畅,围手术期无死亡、脑梗死和肾功能不全等并发症发生。结论 "烟囱"技术拓展了胸主动脉病变腔内治疗的适应证,微创、安全、有效,远期疗效尚待随访、观察。

Objective To evaluate the feasibility of chimney technique in thoracic endovascular aortic repair (TEVAR) of aortic lesion without good landing zone. Methods The stent-graft was deployed covering main branch arteries in the cases without enough landing zone during TEVAR. A chimney stent of bare stent was put in the branch arteries to maintain blood flow. The data of 6 cases in our hospital were retrospectively analyzed to discuss the indications and technical details of chimney method. Results 1 case of thoracic penetrating aortic ulcer(PAU) and 5 cases of aortic dissection(Debakey Ⅲ) were involved in this group. Chimney stents were inserted in left common carotid artery in 3 cases and left subclavian artery in 3 cases. The lesions were isolated well and the branch arteries with chimney stent were kept patency after the stent-grafts and chimney stents inserted. No complications such as stroke and kidney dysfunction happened. Conclusions Chimney technique expand the applicability of TEVAR for patients with challenging anatomy. It is a safe, effective and microinvasive method in the treatment of thoracic aortic lesions.