腔内重建胸腹主动脉病变分支血管的单中心研究

Reconstruct abdominal aortic branch arteries totally by endovascular repair in complex aortic aneurysms： a single-centre experience

目的总结采用完全腔内重建腹主动脉分支血管的方法治疗胸腹主动脉病变的单中心经验。方法对解放军总医院血管外科2011年1月至2014年12月采用腔内重建腹主动脉分支血管技术治疗的70例复杂主动脉病变的临床资料进行回顾性分析。70例患者中，烟囱技术修复47例，三明治技术修复6例，开窗技术修复15例，多分支技术修复2例。术后1周、3、6和12个月及此后每年随访1次，主要随访项目为CT血管造影和磁共振血管造影。随访主要指标为内脏靶血管支架通畅情况及内漏发生情况，次要指标为并发症发生情况。结果随访时间3-47个月，平均随访21个月。烟囱、三明治、开窗及多分支组术中Ⅰ型内漏发生比例分别为9/47、5/6、2/15、0，术后30 dⅠ型内漏发生比例分别为7/47、2/6、0、0。烟囱组随访期间共出现3支靶血管支架闭塞，靶血管通畅率为95.1%（58/61），其他各组随访期间靶血管均通畅。结论烟囱、三明治、开窗及多分支均显示了良好的近中期效果，远期效果仍需进一步的研究验证。

ObjectiveTo report experiences and results of complex aortic aneurysms involving the visceral arteries treating by total endovascular repair.MethodsSeventy cases of thoracoabdominal aortic lesions treating by total endovascular repair in Department of Vascular Surgery, People＇s Liberation Army General Hospital from January 2011 to December 2014 were retrospectively analyzed. There were 47 cases underwent chimney technique, 6 underwent sandwich technique, 15 underwent fenestration technique and 2 underwent branched stent grafts technique. ResultsThe average follow-up time was 21 months, range from 3 to 47 months. Completion angiography showed that typeⅠ endoleak of chimney, sandwich, fenestration and branched stent grafts group were 9/47, 5/6, 2/15 and 0, respectively. While at 30-day typeⅠ endoleak reduced to 7/47, 2/6, 0 and 0. During follow-up, there were 3 target vessel stents occlusion in chimney group, the patency rate of target vessel stent was 95.1% （58/61）. In sandwich, fenestration and branched stent grafts group, all the target vessel stents kept patent.ConclusionIn this study, chimney, sandwich, fenestration and branched stent grafts techniques show good short-term and midterm results, the long-term effects still need further studies.