腔内修复联合动脉旁路术治疗近端锚定区不足的主动脉夹层

Endovascular repair combined with arterial bypass for the treatment of aortic dissection with insufficient proximal anchorage zone

目的探讨覆膜支架完全封闭左锁骨下动脉联合动脉旁路手术治疗近端锚定区不足的StanfordB型主动脉夹层的效果。方法2006年3月至2010年12月收治近端锚定区不足的StanfordB型主动脉夹层患者9例。术前对患者行CT主动脉造影、心脏彩色多普勒超声等获得主动脉夹层的解剖学资料。术中在DSA监视下对9例StanfordB型主动脉夹层行完全封闭左锁骨下动脉的覆膜支架置人腔内修复术，并加行右锁骨下动脉至左锁骨下动脉转流或左颈总动脉至左锁骨下动脉转流术。术后观察手术疗效以及有无并发症。结果患者手术顺利，支架全部成功置人，转流手术成功。手术时间为1．9～3．4h，平均2．8h，失血量60—150ml，平均100ml，围手术期患者无死亡，均痊愈出院。术后随访2～7年，无并发症发生。结论覆膜支架完全封闭左锁骨下动脉加动脉旁路手术治疗近端锚定区不足的StanfordB型主动脉夹层具有疗效确切、创伤小、并发症少及住院时间短的优势。

Objective To evaluate the therapeutic effect of endovascular complete occlusion of left subclavian artery by using covered stent combined with arterial bypass in treating Standford B type aortic dissection which has insufficient proximal anchorage zone. Methods During the period from March 2006 to Dec. 2010, a total of 9 patients with Standford B type aortic dissection which had insufficient proximal anchorage zone were admitted to the hospital. Before surgery, CT angiography of aorta, cardiac color Doppler ultrasonography, etc. were performed to observe the anatomical detail of the dissection. Guided by DSA, endovascular complete occlusion of left subclavian artery by using covered stent together with the creation of an arterial bypass from right subclavian artery to left subclavian artery or from left common carotid artery to left subclavian artery were carried out in all patients. After the operation the clinical effect was evaluated and the occurrence of complication was under observation. Results The surgical procedure was accomplished in all patients. The covered stent was successfully implanted and the shunt was also successfully created. The operation time varied from 1.9 to 3 - 4 hours with a mean of 2.8 hours. The amount of blood loss during operation was 60 - 150 ml with a mean of 100 ml. No death occurred in perioperative period. All patients recovered fully at the time of discharge from hospital. The patients were followed up for 2 - 7 years, and no complications were seen. Conclusion For the treatment of Standford B type aortic dissection which has insufficient proximal anchorage zone, cndovascular complete occlusion of left subclavian artery by using covered stent together with the creation of an arterial shunt is effective and mini- invasive with fewer complications, besides, the patient＇s hospitalization time is shorter. （J Intervent Radio1, 2013, 22： 727-729）