利用左锁骨下动脉开口为锚定区行胸主动脉瘤的腔内治疗

Occlusion of the left subclavian artery orifice during stent-graft implantation in the thoracic aorta

目的总结利用左锁骨下动脉（LsA）开1：3为锚定区行腔内治疗胸主动脉瘤的经验和体会。方法2003年10月至2007年7月共完成覆膜支架腔内隔绝术治疗胸主动脉瘤146例，其中男106例，女40例；年龄29～72岁，平均（53．7±13．8）岁。其中StanfordB型夹层动脉瘤133例，破口位于降主动脉的Stanford A型4例，假性动脉瘤6例，外伤致胸降主动脉破裂3例。锚定区为LSA开口（Z2区）者30例（21％）。结果全组无围术期死亡。无脊髓损伤、支架移位、急性脑缺血、左上肢功能受损等严重并发症。术后平均住院（4．0±1．3）d。术后并发症包括发热35例，Ⅳ型内漏14例，Ⅰ型内漏2例，肾功能衰竭和一过性晕厥各1例。随访1～48个月，期间无严重并发症。结论覆膜支架腔内隔绝术是一种治疗胸主动脉瘤的有效方法，手术创伤小、术后恢复快，疗效肯定、安全性高。部分病例可以利用LSA开口为锚定区，以扩大腔内治疗的范围，增加手术的安全性。

Objective To evaluated the relationship between the site of the proximal landing zone during endovascular repair of thoracic aortic aneurysm and treatment outcomes. Methods From October 2003 to July 2007, 146 patients[ 106 males, 40 females, age （53.7 ± 13.8） years, range 29-72 years] were underwent endovascular stent-graft exclusion for thoracic aortic aneurysm, including Stanford B in 133 patients and Stanford A in 4, pseudoaneurysm in 6, and traumatic aortic rupture in 3. Proximal landing zone at origin of LSA（Z2 zone）were 30 patients（21% ）. Results There were no death and no instances of spinal cord ischemic injury, stent displacement or acute cerebral ischemie injury. Postoperative hospital stay time was （4.0± 1.3） days. Complications included fever in 35 patients, type IV endoleak in 14 patients,type Ⅰ endoleak in 2 patient and acute renal dysfunction in 1 patient and dizziness in 1 patient. Conclusion Endovascular thoracic aorta repair is an effective, less invasive and safe surgery for patients with thoracic aortic aoeurysm. Coverage of the origin of the left subclavian artery to obtain an adequate proximal landing zone during endograft treatment is well tolerated.