逆向烟囱技术和升主动脉包裹术治疗急性A型主动脉夹层

Reverse chimney technique and ascending aorta wrapping for acute type A aortic dissection

目的 :研究逆向烟囱技术的胸主动脉腔内修复术和升主动脉包裹术治疗急性A型主动脉夹层。方法 :从2013年2月至2017年4月,对17例传统外科治疗高风险的病人,应用逆向烟囱技术行胸主动脉腔内修复术。用潜望镜结构对主动脉弓上分支供血。如升主动脉扩张>40 mm,则开胸行升主动脉包裹术以保护近端锚定区,适配主动脉支架。结果:所有病人均成功施行手术。其中16例行逆向烟囱技术保留主动脉分支腔内修复术,9例腔内修复外加行升主动脉包裹术,7例行弓上动脉旁路术。围手术期死亡率为12%(2/17)。未出现支架内血栓、脑血管意外或外周动脉栓塞等并发症。术后有创血压正常。所有病人随访期间血压均在正常范围。结论:通过尽量避免长时间体外循环的生理干扰,利用逆向烟囱技术腔内修复并选择性加强升主动脉支架锚定区,可提高急性A型主动脉夹层病人的抢救成功率。

Object To summarize thoracic endovascular aortic repair（TEVAR） using reverse chimney technique and ascending aorta wrapping for acute type A aortic dissection. Methods From February 2013 to April 2017, 17 patients with severe complications in whom the conventional surgical procedure was judged to be highly risky were subjected to TEVAR with reverse chimney technique in a periscope configuration to supply all supra-arch branches.If the ascending aorta dilated to more than 40 mm, sternotomy was performed to wrap the ascending aorta and to adapt the aortic stent grafts. Results All patients were treated successfully. TEVAR with reverse chimney technique was used in 16 cases and ascending aorta wrapping in 9 cases and supra-arch bypass in 7 cases. The perioperative death rate was 12%（2/17） in the high risky patients. None of the patients experienced thrombosis in the stent grafts, cere-brovascular accident, or peripheral artery embolism. All patients had normal invasive arterial pressure postoperative and normal blood pressure during follow-up. Conclusions The hybrid procedure that include TEVAR with reverse chimney technique, ascending aorta wrapping and supra-arch bypass without long time of extracorporeal circulation could achieve a higher survival rate in treating the patients with acute type A dissection.