合并迷走右锁骨下动脉的B型主动脉夹层的治疗体验

Treatment of stanford type B aortic dissection involving an aberrant right subclavian artery

目的:总结术中支架人工血管植入术或胸主动脉腔内修复术治疗合并迷走右锁骨下动脉的B型主动脉夹层的初步经验。方法:2010年8月至2017年8月,我中心共收治合并迷走右锁骨下动脉的B型主动脉夹层17例,其中术中支架人工血管植入术7例,胸主动脉腔内修复术10例。结果:术中支架组和腔内修复组均无患者围术期死亡。术中支架组有1例患者术后7d发生胸骨哆开行清创术。腔内修复组无围术期并发症。术中支架组随访13~85个月,平均(54.86±27.01)个月,腔内修复组随访(12~89)个月,平均(51.10±24.71)个月。随访期间两组无死亡病例。结论:合并迷走右锁骨下动脉的B型主动脉夹层应根据不同的解剖特点和合并病变,选择术中支架人工血管植入术或胸主动脉腔内修复术。

Objective： To summarize our experience of treatment of Stanford type B aortic dissection（ TBAD） involving an aberrant right subclavian artery（ ARSA） Methods： From August 2010 to August 2017,17 patients with TBAD involving an ARSA underwent frozen elephant trunk（ FET） implantation（ n = 7） or thoracic endovascular aortic repair（ TEVAR）（ n = 10） Results： There were no in-hospital deaths in either group.One patient in the FET group required a reoperation to treat his dehiscence of sternotomy at 7 days after operation and there were no postoperative complications occurred in the TEVAR group. The mean follow-up was 13-85（ 54. 86 ± 27. 01） months for group FET and 12-89（ 51. 10 ± 24. 71） months for group TEVAR. There were no deaths during follow-up in either group. Conclusion： TBAD involving an ARSA should be treated by differentiated surgery,FET implantation or TEVAR,according to the different anatomical features and combined lesions.