腋-腋动脉人工血管旁路联合腔内修复术治疗复杂型Stanford B型主动脉夹层

Axillary-axillary bypass grafting and endovascular repair therapy for complicated Stanford type B aortic dissection

目的 总结腋-腋动脉人工血管旁路联合腔内修复术治疗复杂型Stanford B型主动脉夹层的经验.方法 2011年2月至2014年12月,16例复杂型Stanford B型主动脉夹层患者于手术室全麻下行腋-腋动脉人工血管旁路术,转介入手术室经股动脉切口行主动脉腔内修复术治疗.结果 所有患者均手术成功,术毕造影均提示破口封闭良好,无内漏,旁路血管通畅.术后无椎基底供血不足及左上肢缺血症状;3例患者术后上肢麻木感,术后1～3个月均消失;左侧气胸1例.随访14例,失访2例,随访时间1～30个月,平均（18.0±3.6）个月,术后45 d猝死1例.术后3个月、1年复查主动脉CTA均示人工血管通畅、支架无移位和内漏,支架远端动脉瘤形成1例.结论 腋-腋动脉人工血管旁路联合腔内修复术治疗复杂型Standford B型主动脉夹层效果满意,手术操作简单易行,可降低手术风险,可减少脑部并发症,术后恢复时间短,具有实用价值.

Objective To summarize the present experience on axillary-axillary bypass grafting and endovas-cular repair therapy for complicated Stanford type B aortic dissection. Methods From Feb. 2011 to Dec. 2014, 16 pa-tients with complicated Stanford type B aortic dissection were all treated with axillary-axillary bypass grafting under general anesthesia and then endovascular repair. Results All 16 patients were successfully operated. The crevasses were perfectly closed. No endoleak was found. And the patency rate after reconstruction was 100%. No ertebrobasilar insufficiency or left upper limb ischemia was found in patients. Three patients were found with upper limbs anaesthe-sia which recovered 1-3 months after the surgery, and one patient was found with left pneumothorax. Of 14 patients who were followed up for 1-30 months, with an average of （18.0 ± 3.6） months）, one died 45 days after the surgery. The aortic CTA at 3 months and 12 months after surgery both showed good graft patency, no stent displacement and no endoleak. However, distal aneurysm was found in one patient. Conclusion Axillary-axillary bypass grafting com-bined with endovascular repair is a safe and effective treatment for complicated Stanford type B aortic dissection. It can help reduce the risk of surgery, a brain complications, and also shorten the recovery time.