升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变

Hybrid treatment of aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair

目的 总结升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变的经验与体会.方法 回顾性分析2002年1月至2013年6月在中山大学附属第一医院血管外科接受升主动脉-颈动脉旁路联合腔内修复术治疗的10例主动脉弓部病变高危患者的临床资料.其中男性9例,女性1例,年龄34 ～71岁,平均年龄（54±14）岁.原发病包括主动脉夹层8例,胸主动脉瘤2例.行正中开胸行升主动脉-无名动脉-左颈总动脉旁路7例,升主动脉-左颈总动脉-左锁骨下动脉旁路3例,同期（5例）或二期[5例,平均间隔（7±4）d]经股动脉植入覆膜支架修复主动脉弓病变.结果 全部手术取得技术成功.术后30 d死亡3例,1例死于脑干梗死,1例死于循环衰竭,1例死于主动脉气管瘘.术后发生Ⅱ型内漏1例.随访1 ～ 132个月,中位随访时间24个月（四分位数间距14个月）,术后1个月、3个月、1年及其后每年复查CT,随访期间7例患者均健康存活、人工血管旁路通畅,除1例Ⅱ型内漏继续存在外,其余支架均无移位和内漏.结论 升主动脉-颈动脉旁路联合腔内修复术可用于治疗一般情况差、难以耐受主动脉置换的主动脉弓部疾病高危患者.

Objective To summarize the experience of treating aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair.Methods From January 2002 to June 2013,10 high risk patients with aortic arch disease were treated with ascending aorta to carotid artery revascularization with subsequent endovascular repair in the First Affiliated Hospital,Sun Yat-sen University.There were 9 male and 1 female patients with a mean age of （54 ± 14） years （ranging from 34 to 71 years）.Of the 10 patients,8 were aortic dissection and 2 were thoracic aortic aneurysm.All aortic arch debranching was performed with mid-sternotomy,including 7 ascending aorta to innominate artery and left common carotid artery bypass,and 3 ascending aorta to left common carotid artery and left subclavian artery bypass.Subsequently,simultaneous （n =5） and staged （n =5,mean interval （7 ± 4） days） endovascular repair were performed via femoral artery.Results Technical success rate was 10/10.The 30 day-mortality was 3/10,including 1 brain stem infarction,1 circulatory failure and 1 aorto-tracheal fistula.Complication included 1 type Ⅱ endoleak.The median time of follow-up was 24 （14） months.CT scanning was performed at 1,3 months and annually thereafter.There was no death and no occlusion of bypass during follow-up.No complication occurred except 1 existing type Ⅱ endoleak.Conclusion Ascending aorta to carotid artery revascularization with subsequent endovascular repair is suitable for high risk aortic arch pathology patients in poor general condition with little tolerance to aortic arch replacement.