胸主动脉夹层动脉瘤腔内隔绝术中移植物释放困难的对策

Management of grafts delivering difficulty in endovascular graft exclusion for thoracic aortic dissection

目的 :探讨胸主动脉夹层动脉瘤 (TAD)腔内隔绝术 (EVGE)中移植物 (SG)释放困难的解决方法。方法 :总结我院 4年来对 TAD进行 EVGE术中遇到 SG释放困难的病例 ,采用强力后撤、导鞘预后撤技术、导鞘闭合技术、旋转技术、贯穿导丝牵张技术等各种方法对输送器前进困难、导鞘后撤困难和 SG展开后输送器退出困难等情况进行处理。 结果 :释放困难病例共 11例 ,5例释放时输送器外导鞘后撤困难 ,经过强力后撤、贯穿导丝牵张技术和导鞘预后撤技术成功将 SG释放 ;3例 SG展开后输送器退出困难 ,应用导鞘闭合技术、旋转技术和贯穿导丝牵张技术后导鞘成功退出 ;2例携载延伸 SG的输送器无法到达预定部位 ,放弃操作 1例 ,另 1例经贯穿导丝牵张技术导引成功。还有 1例输送器携载 SG进入主动脉弓时导致裂口扩大 ,随即转传统手术。 结论 :灵活采用多种技术有助于解决胸主动脉瘤 EVGE中 SG释放困难的问题。

Objective: To study the management of delivering difficulty of the grafts (SG) in the procedure of endovascular graft exclusion (EVGE) for thoracic aortic dissection (TAD). Methods: The cases of delivering difficulty in the last 4 years in our hospital were studied. The techniques of impellingly retreating, pre retreating, sheath locking, turning, and transfixing wire stretching were used to deal with the difficulties in delivery system upping, sheath pulling and delivery system retreating. Results: There were 11 cases of delivery difficulty. In 5 cases of sheath pulling difficulty, the impellingly retreating, pre retreating, and transfixing wire stretching techniques were successfully used. In 3 cases of delivery system retreating difficulty, sheath locking, turning, and transfixing wire stretching techniques were successfully used. In other 2 cases, the delivery systems that carried the cuff could not be located to the desired position. Transfixing wire stretching technique was used in one case, and no additional procedure was used in the other case. In the last case, the tear expanded when the delivery system passed, and the patient was converted to open surgery. Conclusion: Application of multi technique is helpful to manage the difficulties in stent graft deployment.