胸主动脉腔内修复术中左锁骨下动脉重建的现状及进展

Revascularization for left subclavian artery during thoracic endovascular aortic repair: current situation and progress

较传统的开胸主动脉置换术而言,胸主动脉腔内修复术(TEVAR)是一种理想的治疗选择,但是施行TEVAR要求有合适的主动脉支架血管近端锚定区。在一些左锁骨下动脉(LSA)和主动脉病变区距离较短的病例中,只有覆盖LSA开口才能实现锚定区的延长,然而这一操作潜在有即时或延时神经及血管并发症的风险。因此,LSA的处理一直备受争议,例如:是否需要对LSA进行预防性重建?何时以及如何施行重建?笔者对以上问题研究的现状及进展作一综述。

Thoracic endovascular aortic repair（TEVAR） has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal landing zones for stent-graft anchoring. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA’s origin with the endovascular stent graft. However, this maneuver has the potential to cause immediate and delayed neurological and vascular complications. Therefore, the management of LSA is still controversial, such as whether prophylactic LSA revascularization is needed and when, and how to perform a revascularization procedure？ In this paper, the authors present the current situation and progress on the above issues.