一体式主动脉弓分支重建支架治疗累及左锁骨下动脉的主动脉穿透性溃疡疗效分析

Analysis of the efficacy of integrated aortic arch branch reconstruction stent in the treatment of penetrating aortic ulcer involving the left subclavian artery

目的探讨一体式主动脉弓分支重建支架治疗累及左锁骨下动脉(LSA)的主动脉穿透性溃疡(PAU)的临床疗效。方法收集2018年11月至2021年11月于佛山市第一人民医院采用一体式主动脉弓分支重建支架治疗需重建LSA的21例PAU患者的临床资料,统计患者的手术成功率,围手术期和随访期间的并发症发生率、分支支架通畅率。结果21例患者均成功完成Castor支架植入,手术成功率为100%,平均手术时间(156±54)min。术中2例LSA分支支架释放后存在狭窄,分别给予8×40 mm、10×40 mm球囊扩张后狭窄解除。术后2例患者出现股动脉穿刺点血肿,予以对症处理好转;术后1例出现截瘫,予以脑脊液引流、高压氧等对症治疗后症状较前好转,出院时可自行下地行走,无大小便失禁。21例患者围手术期均未发生左上肢缺血、内漏、脑梗死、死亡等。随访6~24个月,平均(14.8±5.2)个月,随访期间LSA分支支架通畅率为100%,无新发截瘫、内漏、死亡等严重并发症。结论一体式主动脉弓分支重建支架(Castor)治疗累及LSA的PAU患者安全、有效,值得临床上推广应用。

Objective To investigate the clinical efficacy of integrated aortic arch branch reconstruction stent in the treatment of penetrating aortic ulcer(PAU)involving the left subclavian artery(LSA).Method The clinical data of 21 patients with PAU who needed reconstructive LSA and treated with Castor stent in the First People's Hospital of Foshan from November 2018 to November 2021 were collected.The surgical success rate,perioperative and follow-up period complication rate,branch stent patency rate were counted.Result All 21 patients successfully received Castor stent implantation,the success rate of surgery was 100%,the average operation time was(156±54)min.During the operation,two cases of LSA branch stent had stenosis after release,and the stenosis was relieved after balloon expansion of 8×40 mm and 10×40 mm,respectively.After the surgery,two patients developed femoral artery puncture point hematoma,and symptomatic treatment improved.After the surgery,one case developed paraplegia,and after symptomatic treatment such as cerebrospinal fluid drainage and hyperbaric oxygen,the symptoms improved compared with before,and he could walk on his own when he was discharged without incontinence.None of the 21 patients had left upper limb ischemia,internal leakage,cerebral infarction,or death during the perioperative period.Follow-up was 6-24 months,with an average(14.8±5.2)months,the patency rate of LSA branch stent was 100%during follow-up,there were no serious complications such as new paraplegia,internal leakage,and death.Conclusion Integrated aortic arch branch reconstruction(Castor)therapy for patients with PAU involving LSA is safe and effective,it is worthy of clinical application.