一體化單分支型主動脈支架腔內修復Stanford B型主動脈夾層的療效體會_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 曹軍生 , 彭珊 , 車轍

河西學院附屬張掖人民醫院血管外科（甘肅張掖 734000）;

Corresponding?author：

曹軍生, Email: caojunsheng.shuai@163.com

Keywords：

一體化單分支型主動脈支架; 腔內修復; 夾層

DOI：

10.7507/1007-9424.202205017

Video：

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目的總結Stanford B型主動脈夾層使用一體化單分支型主動脈支架行腔內隔絕治療的療效。方法 2019年10月至2021年10月期間河西學院附屬張掖人民醫院血管外科對10例破口距離左鎖骨下動脈開口＜2 cm的Stanford B型主動脈夾層使用一體化單分支型主動脈支架（上海微創Castor^TM）行單純腔內修復手術，對比支架置入前后數字減影血管造影（digital subtraction angiography，DSA）結果以及術后2個月和12個月主動脈全程CT成像結果，以手術即時成功率、術后相關存活率、分支通暢率、是否截癱、有無內漏、支架移位及破損作為評價指標。結果 10例患者術中支架均成功釋放，手術即時成功率為100%，手術時間100～140 min、中位數118 min，圍手術期無不良事件發生。術后所有患者均遵醫囑復查，無一例死亡，無截癱發生，無明顯內漏發生，支架主體形態及位置良好，分支支架通暢率為100%，夾層假腔均出現血栓化，假腔直徑縮小9.0～12.5 mm、中位數10.2 mm（肺動脈分叉平面)。結論對于部分破口距左鎖骨下動脈開口＜2 cm或夾層逆撕至左鎖骨下動脈根部的Stanford B型主動脈夾層經一體化單分支型主動脈支架行腔內隔絕治療可取得較滿意的療效。

Citation： 曹軍生, 彭珊, 車轍. 一體化單分支型主動脈支架腔內修復Stanford B型主動脈夾層的療效體會. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(12): 1628-1631. doi: 10.7507/1007-9424.202205017 Copy

1.	Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg, 1991, 5(6): 491-499.
2.	Dake MD, Miller DC, Semba CP, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med, 1994, 331(26): 1729-1734.
3.	Eggebrecht H, Nienaber CA, Neuh?user M, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J, 2006, 27(4): 489-498.
4.	徐江, 胡何節, 王曉天, 等. 亞急性期Standford B型主動脈夾層遠端破口特點及其對腔內修復術患者主動脈重塑的影響. 山東醫藥, 2018, 58(22): 38-41.
5.	Degirmenci T, Gunlusoy B, Kozacioglu Z, et al. Comparison of Ho: YAG laser and pneumatic lithotripsy in the treatment of impacted ureteral stones: an analysis of risk factors. Kaohsiung J Med Sci, 2014, 30(3): 153-158.
6.	Koifman E, Garcia-Garcia HM, Kuku KO, et al. Comparison of the efficacy and safety of orbital and rotational atherectomy in calcified narrowings in patients who underwent percutaneous coronary intervention. Am J Cardiol, 2018, 121(8): 934-939.
7.	秦少華, 高學軍, 郝庭嘉, 等. 單分支支架治療錨定區不足Standford B型主動脈夾層. 中國血管外科雜志(電子版), 2019, 11(1): 28-36.
8.	Chuter TA, Schneider DB. Endovascular repair of the aortic arch. Perspect Vasc Surg Endovasc Ther, 2007, 19(2): 188-192.
9.	Patterson BO, Cobb RJ, Karthikesalingam A, et al. A systematic review of aortic remodeling after endovascular repair of type B aortic dissection: methods and outcomes. Ann Thorac Surg, 2014, 97(2): 588-595.
10.	董智慧, 符偉國, 王玉琦, 等. 胸主動脈腔內修復擴展近端錨定區的探討. 中華外科雜志, 2005, 43(13): 857-860.
11.	Riambau V, B?ckler D, Brunkwall J, et al. Editor’s choice-Mangement of descending thoracic aorta diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovsc Surg, 2017, 53(1): 4-52.
12.	Rizvi AZ, Murad MH, Fairman RM, et al. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg, 2009, 50(5): 1159-1169.
13.	Ferreira M, Montero M, Candiotti L, et al. Deliberate subclavian artery occlusion during aortic endovascular repair: is it really that safe. Euro J Vas Endovasc Surg, 2007, 33(5): 664-667.
14.	陸清聲, 景在平. 開窗移植物腔內隔絕術治療胸主動脈夾層動脈瘤. 中華普通外科雜志, 2006, 21(2): 141.
15.	Redlinger RE Jr, Ahanchi SS, Panneton JM. In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization. J Vas Surg, 2013, 58(5): 1171-1177.
16.	Inoue K, Sato M, Iwase T, et al. Clinical endovascular placement of branched graft for type B aortic dissection. J Thorac Cardiovasc Surg, 1996, 112(4): 1111-1113.
17.	陳菲, 邵娟娟, 賈明, 等. 全胸腹主動脈置換術后脊髓缺血的臨床分析. 心肺血管雜志, 2015, 34(9): 694-697.
18.	Saito N, Kimura T, Odashiro Keita, et al. Feasibility of the single-branched stent-graft implantation for thoracic aortic aneurysm or dissection involving the left subclavian artery: short- to medium-term results in 17 patients. J Vasc Surg, 2005, 41(2): 206-212.

1. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg, 1991, 5(6): 491-499.
2. Dake MD, Miller DC, Semba CP, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med, 1994, 331(26): 1729-1734.
3. Eggebrecht H, Nienaber CA, Neuh?user M, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J, 2006, 27(4): 489-498.
4. 徐江, 胡何節, 王曉天, 等. 亞急性期Standford B型主動脈夾層遠端破口特點及其對腔內修復術患者主動脈重塑的影響. 山東醫藥, 2018, 58(22): 38-41.
5. Degirmenci T, Gunlusoy B, Kozacioglu Z, et al. Comparison of Ho: YAG laser and pneumatic lithotripsy in the treatment of impacted ureteral stones: an analysis of risk factors. Kaohsiung J Med Sci, 2014, 30(3): 153-158.
6. Koifman E, Garcia-Garcia HM, Kuku KO, et al. Comparison of the efficacy and safety of orbital and rotational atherectomy in calcified narrowings in patients who underwent percutaneous coronary intervention. Am J Cardiol, 2018, 121(8): 934-939.
7. 秦少華, 高學軍, 郝庭嘉, 等. 單分支支架治療錨定區不足Standford B型主動脈夾層. 中國血管外科雜志(電子版), 2019, 11(1): 28-36.
8. Chuter TA, Schneider DB. Endovascular repair of the aortic arch. Perspect Vasc Surg Endovasc Ther, 2007, 19(2): 188-192.
9. Patterson BO, Cobb RJ, Karthikesalingam A, et al. A systematic review of aortic remodeling after endovascular repair of type B aortic dissection: methods and outcomes. Ann Thorac Surg, 2014, 97(2): 588-595.
10. 董智慧, 符偉國, 王玉琦, 等. 胸主動脈腔內修復擴展近端錨定區的探討. 中華外科雜志, 2005, 43(13): 857-860.
11. Riambau V, B?ckler D, Brunkwall J, et al. Editor’s choice-Mangement of descending thoracic aorta diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovsc Surg, 2017, 53(1): 4-52.
12. Rizvi AZ, Murad MH, Fairman RM, et al. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg, 2009, 50(5): 1159-1169.
13. Ferreira M, Montero M, Candiotti L, et al. Deliberate subclavian artery occlusion during aortic endovascular repair: is it really that safe. Euro J Vas Endovasc Surg, 2007, 33(5): 664-667.
14. 陸清聲, 景在平. 開窗移植物腔內隔絕術治療胸主動脈夾層動脈瘤. 中華普通外科雜志, 2006, 21(2): 141.
15. Redlinger RE Jr, Ahanchi SS, Panneton JM. In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization. J Vas Surg, 2013, 58(5): 1171-1177.
16. Inoue K, Sato M, Iwase T, et al. Clinical endovascular placement of branched graft for type B aortic dissection. J Thorac Cardiovasc Surg, 1996, 112(4): 1111-1113.
17. 陳菲, 邵娟娟, 賈明, 等. 全胸腹主動脈置換術后脊髓缺血的臨床分析. 心肺血管雜志, 2015, 34(9): 694-697.
18. Saito N, Kimura T, Odashiro Keita, et al. Feasibility of the single-branched stent-graft implantation for thoracic aortic aneurysm or dissection involving the left subclavian artery: short- to medium-term results in 17 patients. J Vasc Surg, 2005, 41(2): 206-212.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

一體化單分支型主動脈支架腔內修復Stanford B型主動脈夾層的療效體會

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