胸主动脉夹层动脉瘤腔内隔绝术中左锁骨下动脉的处置

Disposition of left subclavian artery in endovascular graft exclusion for thoracic aortic dissection

目的 :探讨腔内隔绝术治疗 Stanford B型胸主动脉夹层动脉瘤时左锁骨下动脉开口的处理原则。方法 :对 116例接受腔内隔绝术治疗的 Stanford B型胸主动脉夹层动脉瘤患者进行回顾性分析。 结果 :116例患者中 6 2例左锁骨下动脉开口受到干扰 ,其中 2例完全遮蔽 ,19例有临床症状 ,而术前行颈外动脉 -椎动脉旁路者 ,完全遮蔽左锁骨下动脉后无不适症状。结论 :完全遮蔽左锁骨下动脉可引起左侧椎动脉的急性严重缺血造成严重的并发症 ,术前应根据夹层破口与左锁骨下动脉开口的距离 ,选择性实施左锁骨外动脉 -左椎动脉旁路术。

Objective: To discuss the disposition principle of left subclavian artery in endovascular graft exclusion for Stanford B thoracic aortic dissection. Methods: Totally 116 patients of Stanford B thoracic aortic dissection treated with the endovascular graft exclusion were studied retrospectively. Results: Sixty two patients whose left subclavian arterial opening were disturbed, among them left subclavian arterial opening in 2 patients were occluded completely, 19 patients had clinic symptom. Patients received the bypass of external carotid to vertebral artery before the occlusion of the left subclavian arterial opening had no malaise symptom. Conclusion: The complete occlusion of the left subclavian arterial opening may cause acute ischemia of the left subclavian arterial and lead to severe complications. Before endovascular graft exclusion, the bypass of external carotid to vertebral artery should be chosen according to the distance between the opening of the left subclavian artery and the cleft of the dissection.