马凡综合征复杂胸腹主动脉夹层动脉瘤杂交手术应用人工血管作为远端锚定区的远期良好效果

Long-term stable result of using the prosthetic graft as distal landing zone for hybrid procedure of a complicated thoracoabdominal aortic aneurysm dissection with Marfan syndrome

目的总结1例杂交手术治疗马凡综合征复杂胸腹主动脉夹层动脉瘤将人工血管作为远端锚定区的治疗经验。方法回顾性分析四川大学华西医院血管外科2018年5月收治的1例马凡综合征复杂胸腹主动脉瘤夹层患者的资料,该例患者术中将1根18 mm×9 mm的Gore-Tex Y型人工血管与左髂总动脉分叉处行端-侧吻合,以其作为血管搭桥的流入通道,然后再将自制的5分支人工血管与上述Y型人工血管的主体分叉处行端-侧吻合,并对双侧髂动脉以及内脏动脉进行血管重建,最后从远端锚定区向近端锚定区成功释放主动脉覆膜支架,支架的远端锚定于上述直径18 mm的Y型人工血管主体上。结果该患者手术顺利,手术时间6 h,术中出血约800 mL;术后无严重并发症发生;术后2年随访时CT血管三维重建显示人工血管通畅且未见支架内漏、移位或塌陷/内折,也未出现人工血管移植物和支架移植物感染。结论该新型改良的锚定区解决方案,对于这类由马凡综合征导致的广泛主动脉瘤样扩张同时伴有血管夹层形成的罕见病例不失为一种合适的选择。

Objective Reporting a case of hybrid procedure of extensive thoracoabdominal aortic aneurysm(TAAA)with type B dissection due to Marfan syndrome(MFS)using a prosthetic graft as the distal landing zone for stentgraft.Methods Retrospectively summarize in-hospital profiles of a patient for who was diagnosed as MFS complicated with TAAA and type B dissection and admmited to Vascular Surgery Department of West China Hospital in May 2018.A GORE-TEX 18 mm×9 mm Y-shaped graft was sewn side-to-end to the bifurcation of left common iliac artery as the inflow site,and a self-made penta-limb graft was sewn side-to-end to the bifurcation of the 18 mm graft.The visceral and bilateral iliac arteries were reconstructed subsequently.Then,the release of the stent-graft was designed from distal to proximal.The distal part of the stent-graft was anchored into the main body of the 18 mm Y-shaped graft.Results The patient underwent the operation successfully with a duaration of 6 h,blood loss of about 800 mL.No serious postoperative complications occurred.Computed tomography angiography at 2-year follow-up showed that the bypass grafts were patent without endoleak,stent migration,stent infolding or infections of the vessel graft and endograft.Conclusion This modified management of the landing zone could be a proper choice for this kind of rare case as extensive aneurysm or dissection involved in patients with MFS.