PDA封堵器在胸主动脉腔内修复术中的应用价值探讨

The discussion of the using value of PDA occluder in thoracic endovascular aortic repair

目的探讨累及左锁骨下动脉(LSA)的Stanford B型主动脉夹层患者施行胸主动脉腔内修复术(TEVAR)中,应用动脉导管未闭(PDA)封堵器封堵LSA的疗效及安全性,并附3例报道。方法回顾性分析山东省千佛山医院血管外科2016年诊治的3例累及LSA的Stanford B型主动脉夹层患者的临床和随访资料,近端破口距LSA开口均小于15 mm,且术前评估确定均非左侧椎动脉优势型,Willis环完整,3例患者进行TEVAR术时均采用PDA封堵器完全封闭LSA。结果 3例手术LSA封堵和TEVAR全部成功,分别随访4个月、7个月、13个月,术后3个月主动脉CTA检查均证实:主动脉形态良好,覆膜支架位置和形态良好,LSA封闭完全,无内漏发生,且患者无头晕、头疼等脑缺血症状,左上肢血压较术前下降20~50 mm Hg,无左上肢严重缺血表现。结论对非左侧椎动脉优势型且Willis环完整的Stanford B型主动脉夹层患者,为延长锚定区可采用PDA封堵器彻底而安全的封闭LSA,左上肢可很好的耐受LSA封闭,严格的术前评估和筛选可降低封闭LSA带来的并发症。

Objective To investigate the involvement of left subclavian artery（LSA） Stanford B aortic dissecting aneurysm of thoracic aorta lumen repair（TEVAR）, the application of ductus oale（PDA） closure blocking the efficacy and safety of LSA, with 3 cases reported. Methods The clinical and follow-up data of 3 cases of the patients with the Stanford B aortic dissection were analyzed retrospectively, the LSA openings were less than 15 mm in the proximal end of the gap, and the preoperative evaluation determined that neither the left vertebral artery was superior, the Willis ring was complete, and all three patients were completely closed LSA when TEVAR was performed. Results All the three cases of LSA and TEVAR were successful, followed by 4 months, 7 months and 13 months respectively, and the aorta CTA examination was confirmed in 3 months after surgery. Aortic form is good, the coated stent location and form good, LSA closed completely, no inner leakage occurs, and the patients without cerebral ischemia symptom such as dizziness have a headache, left upper limb blood pressure down 20 to 50 mm Hg compared with preoperative, no left upper limb ischemia performance seriously. Conclusion For the full advantage of left vertebral artery type and Willis ring Stanford type B aortic dissection patients, can be used to extend the anchoring zone PDA closure and safe completely closed LSA, LSA closed left upper limb can be very good tolerance, strict preoperative assessment and selection can reduce the complications of closed LSA.