经皮开窗术治疗主动脉夹层引起的缺血

Percutaneous fenestration for the treatment of ischemia caused by aortic dissection

目的评价经皮开窗术治疗主动脉夹层引起的内脏及下肢缺血.方法 6例主动夹层并发内脏及下肢缺血患者行经皮开窗术,所有患者皆是 Stanford B型夹层,累及的血管有肾动脉(3条)、肠系膜动脉(1条)和下肢动脉(6条).4例行单纯经皮开窗术,1例行开窗及左肾动脉支架置入治疗,1例行开窗及腹主动脉和双侧髂总动脉支架置入治疗.1例患者于开窗后1个月行支架移植物复合体(stent-graft)腔内隔绝术.结果所有6例患者血管重建均成功,其中4例缺血症状消失,2例明显减轻.随访4～12个月,平均 7.6个月,1例患者术后3个月死于主动脉破裂出血,余5例仍存活.无严重的手术相关并发症.结论经皮开窗术或经皮开窗结合支架置入是1种安全、有效的治疗主动脉夹层引起的内脏及下肢缺血的方法.

Objective To evaluate the efficacy of percutaneous fenestration for the treatment of ischemia, both visceral and lower-extremity vessels, caused by aortic dissection. Methods Percutaneous fenestration was performed to treat branch vessel ischemia in 6 patients with complicated aortic dissection. All cases suffered from Stanford type B. The compromised vessel included renal artery （ n = 3 ） , mesenteric artery （ n = 1 ）, and lower-extremity artery （ n = 6）. Four patients were treated with percutaneous balloon fenestration, one with both fenestration and left renal artery stem placement, and one with both fenestration and stents placement in abdominal aortic artery and bilateral iliac common arteries. One patient was treated by endoluminal exclusion with a stent-grafts 30 days after fenestration. Results Revascularization was technically successful in all 6 patients with relief of ischemic symptoms. During a 4 - 12 months follow-up （ mean = 7.6 months） , 5 patients were alive, but one patient died of aortic dissection rupture 3 months after the procedure. No serious procedure-related complication occurred. Conclusion Percutaneous fenestration or percutaneous fenestration with stent placement is a safe and effective method for the treatment of visceral and lower-extremity ischemia caused by aortic dissection.