开窗型覆膜支架腔内修复术联合颈-颈动脉搭桥术治疗主动脉弓部动脉瘤

Windowed stent-graft repair combined with R-L carotid grafting in treatment for aortic arch aneurysm

目的:探讨开窗型覆膜支架腔内修复术联合颈-颈动脉搭桥的新方法治疗主动脉弓部动脉瘤的临床价值。方法:首先行右颈动脉-左颈动脉人工血管搭桥术,然后经股动脉将开窗型覆膜支架送入主动脉弓,使窗口对准无名动脉。开放支架后将弓部主动脉瘤隔绝,并保持无名动脉通畅。结果:2例主动脉弓部动脉瘤病人接受了本术式,均隔绝了瘤腔,无名动脉通畅,脑部供血无影响。例1出现了支架后移,补充植入第二覆膜支架后达到满意疗效。结论:本术式可避免开胸,仅行腔内覆膜支架联合颈部血管手术,方法简单,创伤小,对弓部动脉瘤的治疗有独特优势。

Objective To evaluate a novel method of windowed stent-graft repair combined with R-L carotid grafting in the treatment of aortic arch aneurysm.Methods A graft bridge is constructed from the right carotid artery to the left.After the exposure of the femoral artery,a windowed stent-graft is sent to the level of the aortic arch with the window opened to the innominate artery to maintain the blood supply to the brain.And the aortic arch aneurysm was excluded.Results Two patients were treated by the method.The aneurysm was excluded in both cases,while the innominate artery remained patent to the blood flow,maintaining the blood supply to the brain.In case 1,there occurred a distal migration of the stent-graft,which was corrected by placing an additional stent-graft to seal the endoleak.Conclusions The ＂classical＂ thoracotomy was avoided.The graft bridging in the neck combined with the endovascular stent-graft repair is simple and mini-invasive.It is specific in the treatment of arch aneurysm.