近端锚定区保护的三明治技术修复主动脉弓及升主动脉治疗Stanford A型夹层

Sandwich technique for repair of type A acute aortic dissection

目的 探讨近端锚定区保护的三明治技术修复主动脉弓及升主动脉治疗Stanford A型夹层的可行性.方法 2013年至2016年,对中南大学湘雅医学院海口医院(海口市人民医院)12例具有传统外科治疗高风险的患者,使用三明治技术进行胸主动脉腔内修复术,使用潜望镜结构对主动脉弓上分支供血.如果升主动脉扩张超过40 mm,则开胸进行升主动脉包裹术以适应于主动脉支架.结果 患者均成功接受腔内治疗或者杂交手术治疗.围手术期死亡2例,死亡率为17％,未出现支架内血栓、脑血管意外或外周动脉栓塞等并发症.患者平均随访时间为(23±14.5)个月,随访期间内收缩压、舒张压以及有创血压均在正常范围内.结论 升主动脉包裹保护近端锚定区的逆灌注分支腔内修复术可以用于急性Stanford A主动脉夹层治疗.

Objective We aimed to describe a new designed endovascular procedure for acute Stanford type A aortic dissection.Methods From 2013 to 2016,12 patients with severe complications in whom the conventional surgical procedure was judged to be highly risky were subjected to a retrograde-perfusion thoracic endovascular aortic repair with a sandwich technique in a periscope configuration to supply all supra-arch branches.If the ascending aorta was dilated to more than 40 ram,sternotomy was performed to wrap the ascending aorta to adapt to the aortic stent grafts.Results All patients underwent successful treatment with the endovascular or hybrid repair procedure.The perioperative death rate was 17％ in the high risky patients.None of the patients experienced thrombosis in their stent grafts,cerebral accident,or peripheral artery embolism,and all patients had normal systolic pressure,diastolic pressure,and invasive arterial pressure at follow-up.Conclusions A procedure that combines sandwich/periscope grafting with thoracic endovascular aneurysm repair,aorta wrapping,and supra-arch bypass grafting can be used to treat patients with Stanford type A aortic dissection.