体外开窗与激光原位开窗重建左锁骨下动脉的比较研究

Extracorporeal fenestration vs.laser in situ fenestration for reconstruction of the left subclavian artery in patients with aortic arch diseases

目的比较对主动脉弓部病变患者分别采用体外开窗与激光原位开窗技术重建左锁骨下动脉的有效性及安全性。方法回顾性分析2020年1月至2023年10月本中心收治的重建左侧锁骨下动脉的胸主动脉夹层、主动脉瘤和主动脉壁间血肿患者的临床及随访资料。结果38例患者行体外开窗重建左锁骨下动脉,42例患者行激光原位开窗重建左锁骨下动脉,技术成功率分别是97.4%和97.6%,两组比较差异无统计学意义(P>0.05)。术后CTA检查显示夹层原发破口完全闭合,体外开窗出现3例Ⅱ型内漏,激光原位开窗出现2例Ⅱ型内漏,开窗支架内血流通畅。围手术期体外开窗组术后出现1例轻度脑梗死(2.6%),1例轻度截瘫,其余患者无相关并发症发生。结论对于需要重建左锁骨下动脉的主动脉弓部病变患者,应用体外开窗技术和激光原位开窗技术均是有效、安全的。

Objective To compare the effectiveness and safety of in vitro fenestration and in situ fenestration for reconstruction of the left subclavian artery in patients with aortic arch diseases.Methods A retrospective analysis was conducted on 80 patients with thoracic aortic dissection,aortic aneurysm,and aortic intramural hematoma involving the left subclavian artery at our center from Jan 2020 to Oct 2023.Results Thirty-eight patients underwent in vitro fenestration to reconstruct the left subclavian artery,while 42 patients underwent in situ laser fenestration to reconstruct the left subclavian artery.The technical success rates were 97.4% and 97.6% respectively,without statistically significance(P>0.05).Postoperative CTA examination showed that the primary rupture of the dissection was completely closed,3 cases had type Ⅱ endoleak in vitro fenestration,and 2 cases had type Ⅱ endoleak in laser in situ fenestration.The blood flow inside the fenestration stent was fluent.During the perioperative period,one patient in the in vitro fenestration group experienced mild cerebral infarction(2.6%),one patient had mild paraplegia,and no related complications occurred in the other patients.Conclusion For patients with aortic arch diseases,both in situ laser fenestration and in vitro fenestration are safe and effective.