经股动脉覆膜支架植入术的临床应用

Transfemoral covered stent placement for treatment of thoracic aortic aneurysm

目的 :总结经股动脉覆膜支架植入术治疗胸主动脉夹层动脉瘤的手术步骤和并发症处理。方法 :①经左肱动脉置入猪尾巴导管至升主动脉 ,进行造影 ,确定动脉瘤内膜瘘口位置并作标记 ;②在透视下经股动脉将长导丝送至升主动脉 ;③沿长导丝将 2 4F支架推送器放至动脉瘤瘘口位置 ,释放支架 ;④置入猪尾巴导管至升主动脉 ,造影复查。结果 :6例内支架植入位置准确 ,主动脉瘘口被封堵 ,狭窄的主动脉真腔基本恢复正常。无严重心脑血管并发症。结论 :与传统的胸主动脉瘤手术相比 ,支架植入术具有创伤小、出血少、心脑血管及肺部并发症少的特点 ;控制性低血压是预防和减少并发症的有力措施 ;

Objective:To present the method and complication management in transfemoral covered stent placement for treatment of thoracic aortic aneurysm.Methods:A cardiac catheter was inserted to the ascending aorta from the left humerus artery and aortography was made to reconfirm the leak orifice of the aneurysm;A long catheter was inserted to the ascending aorta from femoral artery under X ray;A 24F stent senter was introduced to the descending aorta along with the long catheter,and covered stent was delivered;Aortography was done again to confirm the stent's position.Results:Aortography showed that all endoluminal stents were delivered to their right sites,orifice of the aneurysms were excluded by covered stents,and the compressed aorta was nearly re normalized.No serious cardiovascular and cerebral complications happened perioperatively.Conclusion:Treatment of thoracic aortic aneurysm with transfemoral covered stent placement is characterized by less traumatic,bleeding and lower morbidity of cardiopulmonary cerebral complications compared to conventional surgical therapy.It is most important to have blood pressure controlled at a low level under monitoring of direct arterial pressure.