应用第3代Amplatzer管塞治疗主动脉病变外科手术后吻合口漏的可行性和有效性

Feasibility and efficacy of transcatheter closure of anastomotic leakage after aortic surgery using Amplatzer Vascular Plug Ⅲ

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.