＂烟囱＂技术在主动脉弓病变腔内修复术中的应用

The application of chimney technique in TEVAR of aortic arch lesions

目的 探讨＂烟囱＂技术在主动脉弓腔内修复术中应用的可行性.方法 针对近端锚定区偏短的主动脉弓病变,在腔内修复过程中先覆盖重要主动脉弓分支血管,然后通过腔内技术在被覆盖的分支血管内行＂烟囱＂支架置入术.回顾性统计2004年8月至2009年8月应用＂烟囱＂技术处理病变的临床资料,分析应用＂烟囱＂技术的原因、方法、结果和并发症状况等.结果 本组共27例主动脉弓病变腔内修复技术中应用了＂烟囱＂技术,男性25例,女性2例.年龄37～84岁,平均（67.2±3.8）岁.针对无名动脉的＂烟囱＂技术3例,针对左颈总动脉的＂烟囱＂技术11例,针对左锁骨下动脉的＂烟囱＂技术13例.5例术后即刻造影提示存在少量I型内漏（18.5%）.1例术中因左颈总动脉穿刺造成了该动脉夹层.1例术后因呼吸衰竭死亡.无中风、出血等并发症发生.随访时间3～60个月,平均（16.8±5.9）个月.1例次要脑梗死,1例＂烟囱＂支架闭塞.1例术后4年因心肌梗死死亡.所有I型内漏均消失,无支架型血管和＂烟囱＂支架移位等并发症.结论 ＂烟囱＂技术有效提高了锚定区长度,能很好的降低I型内漏的发生率.但应严格选择适应证,防止可能带来的并发症.

Objective To evaluate the feasibility of chimney technique during thoracic endovascular aneurysm repair（TEVAR） in aortic arch lesions. Methods The stent-graft was deployed covering super arch branch artery in arch lesions in case there was not enough landing zone. A chimney stent was put in the super arch branch artery. We retrospectively analyzed the data of this group, aiming at summarizing the indications, methods, results and complications of chimney technique. Results From August 2004 to August 2009, 27 aortic arch lesions were treated by TEVAR with chimney stent, male/female ratio was 25/2, average age was 67. 2 ±3. 8 years, including3 chimney stents for innominate artery, 11 chimney stents for left common carotid artery and 13 chimney stent for left subclavian artery. Type I endoleaks were encountered in 18. 5% （5/27） of this group by final angiogram. Left common carotid artery dissection was caused by puncture in one case. One patient died of respiratory failure. There was no postoperative stroke nor bleeding. Discharged patients were followed up from 3 to 60 months, averaging at 16. 8 months. There was one death from MI 4 years later. There was minor stroke and left subclavian artery chimney stent occlusion in one each cases during the follow-up. All endoleaks were sealed without stent migration. Conclusion Chimney technique improves the length of landing zone and decreases effectively the endoleak rate.