腔内隔绝术同期封堵左锁骨下动脉的安全性

SAFETY OF SIMULTANEOUS OCCLUSION OF THE LEFT SUBCLAVIAN ARTERY DURING THORACIC ENDOVASCULAR AORTIC REPAIR

目的探讨腔内隔绝术治疗Standford B型夹层或动脉瘤直接封堵左锁骨下动脉(LSA)而不进行血运重建的安全性。方法回顾性分析主动脉夹层腔内隔绝手术(TEVAR)病人156例的临床资料,其中84例完全封堵了LSA,72例未封堵LSA。随访1~7年,比较两组病人术后上肢缺血、脊髓缺血、卒中、死亡以及是否需要行血运重建等指标差异。结果手术后封堵组与未封堵组上肢持续缺血发生率、椎动脉窃血发生率、脑卒中发生率、再次血运重建率及病死率比较,差异均无统计学意义(P>0.05)。结论对于需要行TEVAR且颈动脉、椎基底动脉及Wills环均正常病人,当近端胸主动脉病变与LSA距离<15 mm时,为获得足够安全锚定区而封堵LSA是安全可行的。

Objective To investigate the safety of simultaneous occlusion of the left subclavian artery(LSA)without revascularization during thoracic endovascular aortic repair(TEVAR)for the treatment of Stanford type B dissection or aneurysm.Methods A retrospective analysis was performed for the clinical data of 156 patients who underwent TEVAR for aortic dissection,and among these patients,84 underwent complete occlusion of the LSA and 72 did not receive such occlusion.The patients were followed up for 1-7 years,and the two groups were compared in terms of upper limb ischemia,spinal cord ischemia,stroke,death,and the need for revascularization after surgery.Results There were no significant differences in the incidence rates of persistent upper limb ischemia,vertebral artery steal,and stroke,the rate of revascularization,and mortality rate between the two groups(P>0.05).Conclusion For patients who need TEVAR and have normal carotid artery,vertebrobasilar artery,and Wills ring,when the distance between proximal thoracic aortic lesion and the LSA is less than 15 mm,it is safe and feasible to occlude the LSA in order to obtain a sufficient safe anchoring area.