应用预开窗支架技术治疗主动脉夹层动脉瘤

Physician-modified fenestrated stent grafts for aortic dissection aneurysm

目的 探讨应用预开窗支架技术修复累及内脏动脉区的主动脉夹层动脉瘤的安全性和有效性.方法 回顾性分析2018年1至6月南京鼓楼医院血管外科应用腹部预开窗支架技术治疗的9例主动脉夹层动脉瘤患者的临床资料.结果 3例患者采用Zenith TX2支架进行预开窗、6例采用Ankura支架预开窗,其中四开窗6例、三开窗3例.术中重建内脏动脉血运技术成功率为97.0%(32/33),1例患者术中左肾动脉重建失败(由远端破口逆向血供,3个月后再次重建成功);无Ⅰ型内漏,3例Ⅱ型内漏,2例Ⅲ型内漏;无围手术期死亡及神经系统并发症;平均手术时间(303±51) min,平均住院时间(17.0±2.5)d.术后中位随访时间6.1个月(3~10个月),所有桥接支架通畅,平均瘤体最大直径明显缩小;1例Ⅱ型内漏、2例Ⅲ型内漏仍存在,其瘤体直径未见明显变化.结论 预开窗支架技术治疗累及内脏动脉区的主动脉夹层动脉瘤是安全、有效的.

Objective To evaluate the safety and efficacy of fenestrated endovascular aortic repair (fEVAR) using physician-modified stent grafts(PMSGs) to repair aortic dissection aneurysm.Methods Nine consecutive patients who underwent fEVAR using PMSGs from Jan 2018 to Jun 2018 were retrospectively reviewed.Results Nine PMSGs (6 Ankura stent grafts,3 COOK Zenith stent grafts) were deployed.Initial technical success rate was 97.0% (32 of 33).Mean operative time was (303 ± 51) min.There were no in-hospital death and no perioperative neurology complications.All the patients survived at a median follow-up of 6.1 mouths (ranging 3-10 months).During follow up,no postoperative complications occurred,all target vessels remained patent and no fenestration-related type Ⅰ endoleak were observed.There are 3 cases of type Ⅱ and 2 cases of type Ⅲ endoleaks respectively.Conclusions FEVAR using PMSGs may be a viable alternative for patients with post aortic dissection aneurysm.