胸主动脉夹层动脉瘤腔内隔绝术中贯穿导丝牵张技术的应用

Application of run-through wire stretch technique in the procedure of endovascular exclusion of thoracic aortic dissection

目的 :探讨胸主动脉夹层动脉瘤 (TAD)腔内隔绝术 (EVE)中贯穿导丝牵张技术的应用价值。方法 :EVE术中将一根 2 60cm导丝贯穿肱动脉、锁骨下动脉、主动脉、髂股动脉 ,两端露于体外 ,沿该导丝导入输送器观察 ,帮助克服TAD时EVE中导入困难、撤除困难等情况。结果 :采用贯穿导丝牵张技术4例 ,其中 1例用于主动脉弓扭曲 ,2例用于输送器无法通过第一SG内部 ,1例用于输送器退出困难时 ,均顺利解决了困难 ,帮助手术顺利完成。结论 :贯穿导丝牵张技术可避免许多并发症 。

Objective:To evaluate the technique of stretching the run-through wire in the procedure of endovascular exclusion(EVE) of thoracic aortic dissection(TAD).Methods:In the EVE procedure,a 260cm-long wire was inserted into the humeral artery,subclavian artery,aorta,iliac and femoral artery,and two ends were maintained out of the body.The delivery system was sent along the wire to deal with the difficulties when advancing or retreating of the delivery system.Results:The wire-stretch technique was applicated in four cases.In one case,there was a tortuous aortic arch.In two cases,the delivery system could not pass the lumen of the stent-graft that deployed firstly.In other one case,the delivery system was difficult to be retreated.All the difficulties were overcomed successfully.Conclusion:Application of the technique of stretching the run-through wire may avoid some complications in the EVE,and somehow to get twice the result with half the effort.