摘要
目的探讨应用第3代Amplatzer血管塞(AVP Ⅲ)封堵主动脉病变外科手术后吻合口漏的可行性和有效性。方法纳入2017年1至6月在北京安贞医院应用AVP Ⅲ封堵的主动脉病变(Standford A型主动脉夹层3例,升主动脉瘤1例,永存主动脉干1例)外科手术后吻合口漏患者5例[男性3例,年龄(43.8±13.1)岁],对其临床资料进行回顾性分析。4例患者的漏口位于升主动脉,1例患者的漏口位于主动脉弓与置入的支架间。3例患者存在主动脉-右心房漏,导致进行性心力衰竭;1例导致主动脉与肺动脉间的假性动脉瘤;1例导致夹层假腔持续灌注。患者均通过建立股-股轨道的方式置入AVP Ⅲ,术后对患者进行随访,观察介入治疗的效果。结果5例患者成功置入AVP Ⅲ 6枚,1例患者术后存在微量残余分流。患者在术后随访6(1,6)个月。3例心力衰竭患者心功能由术前纽约心脏协会(NYHA)心功能分级Ⅱ~Ⅳ级提高至术后Ⅰ~Ⅱ级。3例主动脉-右心房分流患者的右心房收缩压由术前的(24.3±2.3)mmHg(1 mmHg=0.133 kPa)降低至术后的(8.7±1.8)mmHg(P=0.03)。1例患者的假性动脉瘤瘤腔直径缩小,1例患者的假腔完全血栓化。结论初步经验表明,AVP Ⅲ封堵主动脉病变外科手术后吻合口漏可行、有效。
ObjectiveTo investigate the feasibility and efficacy of transcatheter closure of anastomotic leakage after aortic surgery using Amplatzer Vascular Plug Ⅲ (AVP Ⅲ).MethodsA retrospective analysis was performed in 5 patients with anastomotic leakage after aortic surgery, who underwent transcatheter closure in our hospital from January to June 2017 using AVP Ⅲ. Surgeries were performed in 3 cases of Standford type A dissection, 1 case of ascending aortic aneurysm and 1 case of persistent truncus.There were 3 males,and age was (43.8±13.1) years old. Anastomotic leakages located at the ascending aorta in 4 patients, and the other one located between the aortic arch and the stent-graft.Three of them had aorta-right atrium fistula and patients suffered from progressive heart failure. False aneurysm between aorta and pulmonary artery was formed in 1 patient, and patent aortic false lumenwas found in the other patient. All the AVP Ⅲ were deployed based on a femoral arteriosus loop. Patients were followed up after transcatheter closure to observe the clinical results.ResultsSix AVP Ⅲ were successfully implanted in the 5 patients. Trivial residual shunt was seen in 1 patient after closure. The patients were followed up 6 (1, 6) months. The cardiac function improved from NYHA class Ⅱ-Ⅳ to class Ⅰ-Ⅱ after the procedure in 3 congestive heart failure patients.The right atrium systolic pressure was significantly reduced after the procedure((8.7±1.8) mmHg (1 mmHg=0.133 kPa) vs. (24.3±2.3) mmHg, P=0.03). The diameter of the false aneurysm reduced in 1 patient after the procedure. Complete thrombosis formation of the thoracic false lumen was observed in 1 patient.ConclusionTranscatheter closure of anastomotic leakage after aortic surgery using AVP Ⅲ is feasible and effective according to our primary experience.
作者
吴文辉
黄连军
蒲俊舟
黄小勇
濮欣
宁一
王肖
Wu Wenhui, Huang Lianjun, Pu Junzhou, Huang Xiaoyong, Pu Xin, Ning Yi, Wang Xiao(Intervenional Department, Beijing Anzhen Hospital, Capital Medical University, Institute of Beijing Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2018年第3期203-207,共5页
Chinese Journal of Cardiology
基金
国家自然科学基金(81570421)
关键词
心血管外科手术
吻合口漏
介入封堵
Cardiovascular surgical procedures
Anastomotic leakage
Transcatheter closure