体外开窗技术治疗EVAR术后内脏分支动脉区域主动脉夹层的技术要点

Technical points of external fenestration in the treatment of aortic dissection involved visceral branch arteries after EVAR

目的 总结体外开窗技术治疗腔内修复术后内脏分支动脉区域主动脉夹层的优点与要点,探索体外开窗技术在内脏分支动脉区域主动脉夹层中的应用效果。方法 对成都市第三人民医院普外介入血管中心收治的1例EVAR术后内脏分支动脉区域主动脉夹层形成并累及多支内脏动脉的患者,采用体外开窗方式重建内脏分支动脉并封堵主动脉血管破口。对该例患者的手术过程进行总结,并对全腔内技术治疗该类疾病的现状进行探讨分析。结果 该患者手术成功,手术耗时5 h,术中出血约100 mL。ICU留观时间为1 d,于术后1周出院。术后无严重并发症(如脊髓缺血、肝肾功能不全、感染、下肢缺血、穿刺点假性动脉瘤等)发生。术后3个月复查主动脉CT血管造影,三维重建显示主动脉支架稳定、内脏分支动脉血流通畅,主动脉夹层隔绝良好。结论 体外开窗技术可实现对累及重要脏器分支动脉的主动脉夹层的全腔内修复,是一种新的处理内脏分支动脉区域主动脉病变的治疗方案。

Objective To summarize the advantages and key points of external fenestration in the treatment of aortic dissection involved visceral branch arteries after endovascular aortic repair(EVAR), and to explore the application effect of external fenestration in aortic dissection involved visceral branch arteries. Methods A patient with abdominal aortic aneurysm resulting in abdominal aortic dissection and involving multiple visceral arteries after EVAR was treated in Center of Vascular and Interventional Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu. The surgical procedure of this patient was summarized, and the current status of total lumen technique in the treatment of such diseases was discussed and analyzed. Results The operation was successful, and it took only five hours, the intraoperative blood loss was about 100 mL, the patient was kept in ICU for one day and discharged one week after surgery and no serious postoperative complications occurred(such as spinal cord ischemia, liver and kidney insufficiency, infection, lower limb ischemia, puncture pseudoaneurysm, etc.). Aortic CT angiography was reexamined in three months after surgery, and the three-dimensional reconstruction showed that the aortic stent was stable, the blood flow of visceral branch arteries was smooth, and the aortic dissection was well isolated. Conclusion Endovascular repair of aortic dissection involving branch arteries of important organs can be achieved by external fenestration technique, it is a new treatment for aortic lesions involved visceral branch arteries.