颈颈动脉转流加开窗型覆膜支架杂交术治疗主动脉弓部动脉瘤

A novel hybrid technique for the aneurysms at the aortic arch

目的:探讨免开胸新方法——颈颈动脉转流加开窗覆膜支架杂交术治疗主动脉弓部动脉瘤的价值。方法:对2例主动脉弓部动脉瘤患者进行颈颈动脉转流加开窗覆膜支架杂交术。首先行右颈动脉-左颈动脉人工血管转流术,然后经股动脉通路将开窗后的覆膜支架植入主动脉弓部动脉瘤处,隔绝瘤腔但保持无名动脉通畅。结果:2例患者均手术成功,转流血管通畅,无脑部缺血或神经意外症状,上肢功能无丧失;左锁骨下动脉和左颈总动脉开口封闭;瘤腔隔绝彻底。结论:对主动脉弓部动脉瘤患者应用颈颈动脉转流加开窗覆膜支架杂交术,能够避免体外循环和开胸手术可能引起的巨大创伤、失血以及剧烈的血流动力学变化,具有操作微创、隔绝彻底、手术简单等优点。但该术式对定位要求较高,术者需具备丰富的腔内覆膜支架植入手术的经验。

Objective： To evaluate the novel technique of carotid-carotid bypass combines with windowed stent-graft in the treatment of aneurysms at the aortic arch without thoracotomy. Methods Firstly, a right to left common carotid artery bypass was established with a graft with rings. Then the stent-graft was windowed at the determined position. Finally, the stent-graft was deploied into the aortic arch to exclude the aqeurysm with the anonyma maintained patent, Re. su/ts： The grafts were patent, and no brain ischemJa or cranial accident occurred, The left upper limbs maintained there function. The left common carotid artery and the left subclavian artery were sealed. The aneurysms were occluded. Conclusions： The technique is a suitable method for the arch aneurysm,and is mini-invasive which may avoid of macro-trauma, large volume of blood loss, and the unstable of the blood dynaminc statement resulting from thoracotomy. The lumen of the aneurysm is still occluded thoroughly, and the procedure is simplified. But only a veteran endovascular doctor may control it safely.