球囊腔内阻断在复杂主动脉手术中的应用

Application of endovascular balloon occlusion in complex aortic surgery

目的总结球囊腔内阻断辅助主动脉手术15例经验。方法15例主动脉术后需再次手术患者,在复合手术室DSA引导进行球囊腔内阻断辅助下主动脉手术。入选条件为血管无法直接阻断者。以术前最后一次CTA图像为标准,测量需要阻断的靶血管直径,选择合适球囊及对比剂用量、血管入路;术中以球囊充盈、固定贴壁良好,远端有创血压波形显示为平流,压力接近静水压作为完全阻断标准。结果15例球囊腔内阻断辅助主动脉手术患者,均阻断完全,手术顺利。术后14例阻断靶血管和血管入路均无并发症发生。1例三分支支架术后再次行胸腹主动脉替换患者,球囊阻断术后支架内皮组织脱落,栓塞腹腔干和肠系膜上动脉,再次手术。结论球囊腔内阻断技术扩大了主动脉手术适应证,简化了手术操作,是一种安全有效的阻断方法;术前应判断靶血管是否适合球囊阻断,避免相关并发症发生。

Objective To summarize the experience of 15 cases of balloon endovascular occlusion assisted aortic replacement.Methods 15 patients who needed reoperation after aortic surgery underwent endovascular balloon occlusion assisted aortic replacement by DSA guidance in the hybrid OR.Main inclusion criteria:The target vessel to be blocked cannot be directly blocked.Based on the last CTA before the operation,the diameter of the target vessel was measured,and the appropriate diameter balloon and the appropriate diameter balloon and the amount of contrast agent were selected.The vascular approach was selected according to the CTA.During the operation,the balloon was filled and fixed well,the distal invasive blood pressure waveform showed advection,and the pressure close to hydrostatic pressure as the complete blocking standard.Results All 15 cases of balloon endovascular occlusion assisted aortic surgery were successful.After the operation,14 target vessels normally without damage,and there was no vascular complication.One case after surgical three-branch stent surgery underwent the second thoracoabdominal aortic replacement operation.After the stent was blocked by the balloon,the new tissue in the stent fell off,and the celiac trunk and superior mesenteric artery were embolized for reoperation.Conclusion Balloon endovascular occlusion technology expands the indications of aortic surgery and simplifies the operation,that is a safe and effective occlusion method.Whether the target vessel is suitable for balloon occlusion should be judged before the operation to avoid related complications.