左锁骨下动脉烟囱技术在Stanford B型胸主动脉夹层腔内修复术中的应用

Chimney technique in left subclavian artery during the procedures of endovascular aortic repair for the Stanford type B aortic dissection

目的探讨左锁骨下动脉烟囱技术在Stanford B型主动脉夹层腔内修复术（EVAR）中的意义和技术要点。方法回顾性分析35例临床和影像学确诊的Stanford B型主动脉夹层,且主动脉撕裂累及到左锁骨下动脉的患者,以CTA作为术前评估方法,术中覆膜支架覆盖左锁骨下动脉,以球囊扩张支架对左锁骨下动脉进行介入再通。结果 35例胸主动脉覆膜支架和左锁骨下动脉球囊扩张支架均放置成功,术后随访3~24个月,35例左锁骨下动脉烟囱支架通畅率100%。结论 Stanford B型胸主动脉夹层的EVAR治疗时,覆膜支架的近侧锚定区选择在正常的主动脉壁,可以降低继发医源性夹层的发生;覆盖左锁骨下动脉后采用烟囱技术可有效预防＂盗血综合征＂的发生,其技术简捷、安全。

Objective To discuss the meaning and technical key points of the chimney technique in left subclavian artery during the procedures of endovascular aortic repair（EVAR） for the Stanford type B aortic dissection.Methods A total of 35 patients with type B aortic dissection diagnosed by clinical and imaging assessments,whose left subclavian artery was involved by dissection,were retrospectively analyzed.All the cases were assessed by CTA before EVAR,their left subclavian arteries were covered by the deployments of stent grafts.The occlusive arteries were recanalized by balloon expanding stents.Results The placements of aortic stent grafts and subclavian arterial stents were successful in all the 35 cases.All the left subclavian arteries were opened during 3—24 months followup.The recanalized rate was 100%.Conclusion In the procedures of EVAR the proximal anchoring zone of stent grafts should be chosen in the normal vascular wall to prevent from available dissection caused by therapies.After the deployments of stent grafts which covered left subclavian arteries,the recanalization with chimney technique can prevent from the occurrence of ＂blood stealing symptoms＂ effectively.It is simple and safe.