杂交技术治疗合并迷走右锁骨下动脉的B型主动脉夹层

Hybrid endovascular repair for type B aortic dissection involving aberrant right subclavian artery

目的 总结合并迷走右锁骨下动脉（aberrant right subclavian artery,ARSA）的Stanford B型主动脉夹层的临床治疗经验。方法 2008年1月至2014年12月广东省人民医院共收治合并ARSA的Stanford B型主动脉夹层患者11例,全部采用非开胸的弓上分支血管旁路术和主动脉腔内修复术（thoracic endovascular aortic repair,TEVAR）相结合的杂交技术（hybrid）进行治疗,覆盖区域的所有主动脉弓上分支血管供血均在实施TEVAR术前得到重建。结果 11例患者均痊愈出院,住院时间为16（12~24）d,无上肢缺血症状及神经系统并发症。术后3个月复查腔内支架均未移位,主动脉胸段假腔血栓化,无内漏发生,旁路术桥血管通畅。结论 合并ARSA的主动脉夹层是罕见的疾病,采用杂交技术（Hybrid）治疗合并ARSA的Stanford B型主动脉夹层方法可行,临床疗效满意,TEVAR术前对覆盖区域所有主动脉弓上分支血管供血进行重建,可避免术后上肢缺血及神经系统并发症。

Objectives To summarize the experience in combined endovascular and surgical（hybrid） repair for Stanford type B aortic dissection involving aberrant right subclavian artery（ARSA）. Methods Data of 11 cases with Stanford type B aortic disease in Guangdong General Hospital were reviewed. By adapting hybrid open and thoracic endovascular aortic repair（TEVAR） techniques, type B aortic dissection involving ARSA was treated. Before TEVAR,supra-aortic bypass to all aortic arch branches involved was built. Results All the 11 patients survived the operation.Hospitalization duration was 16（12-24） d. They had no symptoms of left upper limb ischemia or nervous system complications. There were no immediate complications and no evidence of endoleaks in 3 months postoperatively, but thrombosis of the false lumen in the chest. All the supra-aortic vessels were patent. Conclusions The application of hybrid endovascular repair for Stanford type B aortic dissection involving ARSA is feasible with a satisfactory clinical outcome. Before TEVAR, initial supra-aortic bypass to all aortic arch branches involved is essential to avoid upper limb ischemia and nervous system complications.