模块分叉支架型血管重建犬主动脉弓的可行性研究

The feasibility study of endovascular reconstruction of aortic arch with modular branched stent-graft system in canine

目的设计制作腔内重建犬主动脉弓的模块分叉支架型血管,研究其腔内重建主动脉弓的可行性。方法全组10例动物,主动脉造影测量升主动脉、主动脉弓及其分支血管的相关数据,设计并制作适合于重建犬主动脉弓的模块分叉支架型血管;在 x 线透视引导下,依次自右锁骨下动脉、左锁骨下动脉及股动脉植入支架型血管的三个模块,并在体内对接,完成主动脉弓的重建;观察移植物形态结构、主动脉血流动力学变化及内漏发生状况。结果 8例成功完成各模块的植入,另2例分别于术中死于冠状动脉被封堵和左锁骨下动脉破裂。成功完成介入操作的8例动物术中造影结果显示移植物位置及形态良好,冠状动脉及颈总动脉血流通畅,其中2例发现近端Ⅰ型内漏。结论应用模块分叉支架型血管腔内重建犬主动脉弓在技术方案上是可行的;对腔内重建人体主动脉弓的研究具有指导意义。

Objective To design and manufacture a modular branched stent-graft system of endovascular reconstruction of the aortic arch in canine, and to investigate the feasibility of endovascular repair. Methods After the length and the diameter of ascending aorta, aortic arch and super-arch branched vessel measurement, a modular branched stent-graft system, including two pieces bifurcated stent-graft and one piece straight stent-graft, was designed and manufactured. Under X-ray fluorescope, these three modulars were accessed from right subclavian, left subclavian and femoral artery respectively and connected one by one to reconstruct the aortic arch. The shape and structure of stent-grafts, haemodynamics in aortic arch and endoleak were observed. Results Eight of ten operations were completed successfully. Two dogs died of obstruction of coronary artery and arteriorrhexis of left subclavian respectively during operation. In the eight successful cases, two proxmial type I endoleaks were observed, and no other type endoleak occurred. The shape and the localization of stent-grafts were fine, and the coronary artery and carotid artery were unobstructed. Conclusion It is feasible to reconstruct aortic arch of canine by modular branched stent-graft, and it is significant to direct the research of reconstruction of human aortic arch.