Stanford B型主动脉夹层腔内治疗中封堵左锁骨下动脉86例临床分析

Clinical Analysis of Left Subclavian Artery Coverage during the Endovascular Repair of Stanford type B Aortic Dissection in 86 Cases

目的观察Stanford B型主动脉夹层患者施行腔内修复术中封堵左锁骨下动脉后对颅内及左上肢血供的影响.方法对126例接受腔内修复术治疗的Stanford B型主动脉夹层患者的临床及随访资料进行回顾性分析.结果 126例接受腔内修复术治疗的Stanford B型主动脉夹层患者中86例患者全部或部分封堵了左锁骨下动脉开口;35例完全封堵左锁骨下动脉开口,51例部分封堵左锁骨下动脉开口(封堵程度1/4～2/3);86例患者术后均未出现颅内缺血的表现,12例术后出现左上肢轻微缺血症状,无左上肢严重缺血发生;51例部分封堵左锁骨下动脉的患者左上肢肱动脉收缩压较术前降低15～35 mmHg.结论对于第一裂口离左锁骨下动脉开口<10 mm的Stanford B型主动脉夹层患者,腔内修复术中封堵左锁骨下动脉开口是可行的,术前评估决定是否封堵左锁骨下动脉开口及是否先行颈部血管旁路手术将大大增加手术空间及安全性.

Objective To analyze the influence of left subclavian artery（LSA）coverage on the blood-supply of brain and upper extremity during the endovascular repair（EVR）of Stanford type B aortic dissection（AD）.Method We retrospectively analyzed these clinical and follow-up data of 126 patients with type B dissection who were treated by EVR.Results Among 126 patients with Stanford type B AD who received the endovascular repair（EVR）,86 patients＇ LSA were covered fully or partly.35 patients,LSA were complete covered and 51 patients,ones were partly covered（1/4～2/3）.No severe complications were found in brain and upper extremity.There were 12 patients that presented slight left upper limb ischemia.And the blood pressure of left brachial artery of 51 patients that LSA be covered partly were lower 15～35 mmHg than peroperation.Conclusions For patients with Stanford type B aortic dissection,while the distance from the left subclavian artery to proximate break is less than 10 mm,it is feasible to cover LSA during EVR.But it is very necessary before operation to evaluate the condition of carotid artery,vertebral artery and cerebral arterial circle.