开窗胸主动脉覆膜支架腔内修复治疗主动脉弓疾病近中期疗效分析

Analysis the effects of the fenestrated thoracic endovascular repair for aortic arch disease:short-and mid-term outcomes

目的探讨开窗胸主动脉覆膜支架腔内修复(thoracic endovascular aortic repair,TEVAR)技术在治疗主动脉弓疾病近中期的疗效。方法 2012年4月~2017年1月收治的主动脉弓病变病人57例,均采取体外开窗TEVAR技术进行治疗,以术后即刻有无内漏、支架移位、脑梗死、分支血管通畅率、二次干预及生存结局为有效性观察指标。结果 (1)围术期情况:临床手术成功率为96.5%(55/57),术中并发症为10.53%(6/57),2例窗口定位偏移紧急改为烟囱支架,2例Ⅰ型内漏,2例Ⅲ型内漏,其中3例术后30天复查见术中内漏消失,无新发死亡病例。新发支架相关并发症发生率为3.51%(2/57),其中急性脑梗死、Ⅲ型内漏各1例,Ⅲ型内漏二次手术封堵1例。(2)生存结局:随访时间3~36个月,随访率为92.98%(53/57)。新发支架相关并发症发生率为5.26%(3/57),急性脑梗死、左颈总动脉闭塞、Ⅲ型内漏各1例。二次手术干预2例。死亡3例。3年生存率为89.47%(51/57)。结论应用开窗TEVAR技术治疗主动脉弓疾病近中期疗效安全、有效。

Objective Investigate the effect of the fenestrated thoracic endovascular aortic repair(TEVAR) in the treatment of aortic arch disease.Methods Clinical data of 57 patients with aortic arch lesions admitted to our hospital from April 2012 to January 2017 were retrospectively analyzed.All patients were treated with fenestrated TEVAR technology,and the efficacy was observed by immediate postoperative internal leakage,stent displacement,cerebral infarction,branch vascular patency rate,secondary intervention and survival outcome.Results(1)Perioperative conditions: clinical surgical success rate 96.5%(55/57),intraoperative complications were 10.53%(6/57),2 cases of fenestration position offset emergency to chimney,2 cases of model of leakage,2 cases of Ⅲ type of leakage,3 cases of postoperative leakage within 30 day review intraoperative disappeared,no new deaths.New stent related complication rate 3.51%(2/57),including acute cerebral infarction,Ⅲ leakage in 1 case,Ⅲ leakage in the secondary surgery in 1 case.(2) survival outcome: the follow-up period was 3~36 months,and the follow-up rate was 92.98%(53/57).New stent related complication rate 5.26%(3/57),acute cerebral infarction,left common carotid artery occlusion,Ⅲ type of leakage in 1 case.Two cases of secondary surgical intervention.There were 3 deaths.The 3-year survival rate was 89.47%(51/57).Conclusion The application of fenestrated TEVAR technique in the treatment of aortic arch disease is safe and effective.