急性主动脉夹层腔内修复覆盖左锁骨下动脉的疗效观察

Curative effect observation of left subclavian artery coverage during thoracic endovascularaortic repair of acute aortic dissection

目的 探讨急性主动脉夹层腔内修复术（TEVAR）中覆盖左锁骨下动脉（LSA）的安全性.方法回顾性分析我院心血管外科2010年1月至2016年6月99例行急性主动脉夹层腔内修复术患者资料,其中LSA未封堵53例、部分封堵19例、完全封堵27例.分析比较LSA封堵与未封堵及完全封堵患者围手术期脑卒中及截瘫发生率;随访患者术后远期左上肢缺血症状及脑卒中发生率.结果所有患者住院期间均无左上肢缺血性疼痛;3例（3%）术后发生短暂性脑缺血发作及一过性黑朦,其中2例（2%）LSA未封堵、1例（1%）LSA封堵;围手术期无截瘫病例.平均随访37.7（2-73）个月,随访结果及统计分析显示,LSA封堵可能增加中期脑卒中发生率,患者双上肢血压差及左上肢缺血症状有差异.结论LSA封堵不增加TEVAR术围手术期脑卒中及截瘫风险,可能增加术后远期脑卒中风险.为缓解左上肢远期缺血症状,可能需要择期行LSA血运重建.

Objective To evaluate the safety of covering the left subclavian artery（LSA）in the endovas-cular repair of acute aortic dissection （TEVAR）. Methods Retrospective analyses were conducted on 99 cases of acute aortic dissection in patients undergoing endovascular repair during January 2010 to June 2016 in our hospi-tal,in which cases,LSA without plugging were 53 cases,partial closure were 19 cases,blocking were 27 cases. Analysis and comparison the performance of stroke and the incidence of paraplegia between each group in perioper-ative period,and following up long-term postoperative of patients with left upper limb ischemia symptoms and the incidence of stroke. Results During the period of hospitalization all patients were free of left upper limb ischemic pain;3 cases（3%）occurred in TIA and a black haze after surgery,including 2 cases（2%）without plugging and 1 case（1%）of LSA blocking; none perioperative paraplegia. Mean follow-up were 37.7 months（2-73）. The results were analyzed for statistical significance,which showed that LSA blocking may increase the incidence of stroke in mid-term follow-up,and upper limb blood pressure and left upper limb ischemia symptoms were different. Conclusion LSA Blocking in TEVAR does not increase stroke risk and paraplegia in perioperation period,may increase the long-term risk of stroke after operation. For alleviating the lack blood symptoms of left upper limb in long-term. It should to be scheduled for LSA revascularization.