主动脉夹层累及主动脉弓时左锁骨下动脉的处理策略及研究进展

Management strategy and research progress of left subclavian artery in aortic dissection involving aortic arch

随着胸主动脉腔内修复术(TEVAR)的应用,腔内治疗已成为Stanford B型主动脉夹层(TBAD)的一线治疗方法。然而,对于累及主动脉弓远端的TBAD术中是否需要保留左锁骨下动脉(LSA)仍存在争议。对比分析TEVAR术中采取不同的LSA处理策略后脑卒中、脊髓缺血(SCI)、左上肢缺血3种术后并发症各自的风险和发生率。根据不同患者的病变部位,择期患者应常规实施LSA血运重建,紧急情况下可逐个进行评估,经充分考虑后制定最优的个体化治疗方案是LSA治疗策略的发展方向。

With the application of thoracic endovascular aortic repair(TEVAR),endovascular treatment has become the first-line treatment method for Stanford B-type aortic dissection(TBAD).However,whether it is necessary to preserve the left subclavian artery(LSA)in TBAD involving the distal aortic arch remains controversial.To compare and analyze the risk and incidence rate of postoperative complications of stroke,spinal cord ischemia(SCI)and left upper limb ischemia with different LSA treatment strategies during TEVAR.According to the lesion location of different patients,routine LSA revascularization should be performed in selected patients.In emergency situations,it can be evaluated one by one,and the optimal individualized treatment plan can be made after full consideration.This is the development direction of LSA treatment strategy.