胸主动脉覆膜支架原位开窗技术的应用现状

Progress on in situ fenestration during thoracic endovascular aortic repair

主动脉弓部病变血管内治疗因病变部位解剖复杂、毗邻重要分支而颇具挑战性。主动脉支架原位开窗技术作为处理此类复杂部位病变的一种超适应证方法,充分利用目前可获得的器械,在保留弓上分支血管的前提下,尽可能发挥胸主动脉血管内修复术的微创优势。原位开窗技术的特点是释放主体支架后,通过在支架壁上运用不同方法破膜,形成与分支血管对合的窗口,再通过窗口植入分支支架,维持隔绝区域分支血管的血流。该技术目前临床应用越来越广泛。本文就原位开窗技术的操作步骤以及临床应用进展作一综述。

Endovascular aortic arch repair remains challenging due to the complicated anatomy and the involved vital branches. Off-label techniques emerged during the last decade, including endografts with parallel stents(known as Chimney, Periscope, Sandwich), surgeon-modified endografts, and various other reported techniques. In situ fenestration of standard endografts represents another off-label endovascular means to maintain perfusion to aortic side branches located in the excluded area. Its principle is based on fenestration of an endograft following its deployment inside the vascular system. As data are emerging regarding in situ fenestration, the aim of this article is to review recent progress of technical descriptions, in vitro and clinic results of in situ fenestration from the available literature.