经导管封堵治疗六例升主动脉病变外科术后吻合漏

Transcatheter closure of anastomotic leakage after surgical procedures for noninfected ascending aortic pathology

目的：分析非炎性升主动脉病变外科术后吻合口漏，用封堵器材行介入治疗的安全性和有效性。方法连续6例因主动脉病变外科手术后发生主动脉吻合口漏患者，接受封堵介入治疗。其中4例升主动脉人工血管近段吻合口漏，2例形成升主动脉根部假性动脉瘤、2例形成升主动脉根部至右心房漏；2例为人工血管远端与支架吻合口漏，引起真腔向假腔持续分流。1例升主动脉至右心房漏建立股静脉至股动脉轨道经静脉侧完成封堵，余5例均经动脉侧完成封堵。4例采用ADOⅡ封堵漏口；1例用2枚可控弹簧圈封堵后，微量残余漏，1个月后再次用1枚ADOⅡ完全封闭残余漏口；1例采用Ⅰ代动脉导管未闭封堵器。结果6例患者均成功封堵漏口，封堵器植入成功，无脱落。术中造影5例无残余分流；1例残余微量分流者术后1个月再次行介入成功封堵。全部患者胸痛、胸闷症状缓解或消失。结论采用封堵器介入封堵升主动脉外科术后吻合口漏，安全有效，可用于漏口不贴近瓣膜及重要分支血管开口的吻合口漏的治疗。

Objective To evaluate the safety and efficiency of transcatheter anastomotic leakage closure after surgical procedures for non-infected ascending aortic pathology with different occlusion devices. Methods From Dec. 2013 to Sep. 2015, six cases received interventional therapy for anastomotic leakage after surgical procedures for non-infected ascending aortic pathology using occluders. Four cases were with proximal graft-vessel anastomotic leakage, including two pseudoaneurysms at the site of aortic roots and two ascending aorta to right atrium shunts. The other two cases were with artificial grafts to intraoperative stent anastomotic leakage leading to endoleak type Ib. The anastomotic leakage was totally occluded by single ADOⅡrespectively in four cases. Two detachable coils were implanted in one case with artificial graft to intraoperative stent anastomotic leakage, but mild residual shunt to false lumen was detected by DSA and follow-up CTA. The second interventional procedure was carried out one month later, and one ADO Ⅱ was used to close the residual leakage totally. One PDA occluder was implanted along arteriovenous guide-wire track via aortic root to right atrium fistula in one case. Results All the anastomotic leakages of the six cases were totally excluded by different occlude devices percutaneously. The technical success rate was 100%. Follow-up time was from 1 month to 4 years. The patients＇ clinical condition improved obviously. Follow-up CTA showed no recurrence of anastomotic leakage. Complete thrombosis and marked shrinkage of the pseudoaneurysm were achieved in two cases, and the partial thrombosis and shrinkage of the false lumen were achieved in 2 cases. Conclusion Trans-catheter closure is an alternative treatment for ascending aortic surgical anastomotic leakage, which may achieve satisfactory＆amp;nbsp;short-and mid-term results.