一体化单分支型主动脉支架腔内修复Stanford B型主动脉夹层的疗效体会_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 曹军生 , 彭珊 , 车辙

河西学院附属张掖人民医院血管外科（甘肃张掖 734000）;

Corresponding author：

曹军生, Email: caojunsheng.shuai@163.com

Keywords：

一体化单分支型主动脉支架; 腔内修复; 夹层

DOI：

10.7507/1007-9424.202205017

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

目的总结Stanford B型主动脉夹层使用一体化单分支型主动脉支架行腔内隔绝治疗的疗效。方法 2019年10月至2021年10月期间河西学院附属张掖人民医院血管外科对10例破口距离左锁骨下动脉开口＜2 cm的Stanford B型主动脉夹层使用一体化单分支型主动脉支架（上海微创Castor^TM）行单纯腔内修复手术，对比支架置入前后数字减影血管造影（digital subtraction angiography，DSA）结果以及术后2个月和12个月主动脉全程CT成像结果，以手术即时成功率、术后相关存活率、分支通畅率、是否截瘫、有无内漏、支架移位及破损作为评价指标。结果 10例患者术中支架均成功释放，手术即时成功率为100%，手术时间100～140 min、中位数118 min，围手术期无不良事件发生。术后所有患者均遵医嘱复查，无一例死亡，无截瘫发生，无明显内漏发生，支架主体形态及位置良好，分支支架通畅率为100%，夹层假腔均出现血栓化，假腔直径缩小9.0～12.5 mm、中位数10.2 mm（肺动脉分叉平面)。结论对于部分破口距左锁骨下动脉开口＜2 cm或夹层逆撕至左锁骨下动脉根部的Stanford B型主动脉夹层经一体化单分支型主动脉支架行腔内隔绝治疗可取得较满意的疗效。

Citation： 曹军生, 彭珊, 车辙. 一体化单分支型主动脉支架腔内修复Stanford B型主动脉夹层的疗效体会. 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, Neuhäuser M, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J, 2006, 27(4): 489-498.
4.	徐江, 胡何节, 王晓天, 等. 亚急性期Standford B型主动脉夹层远端破口特点及其对腔内修复术患者主动脉重塑的影响. 山东医药, 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.	秦少华, 高学军, 郝庭嘉, 等. 单分支支架治疗锚定区不足Standford B型主动脉夹层. 中国血管外科杂志(电子版), 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, 符伟国, 王玉琦, 等. 胸主动脉腔内修复扩展近端锚定区的探讨. 中华外科杂志, 2005, 43(13): 857-860.
11.	Riambau V, Böckler 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.	陆清声, 景在平. 开窗移植物腔内隔绝术治疗胸主动脉夹层动脉瘤. 中华普通外科杂志, 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.	陈菲, 邵娟娟, 贾明, 等. 全胸腹主动脉置换术后脊髓缺血的临床分析. 心肺血管杂志, 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, Neuhäuser M, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J, 2006, 27(4): 489-498.
4. 徐江, 胡何节, 王晓天, 等. 亚急性期Standford B型主动脉夹层远端破口特点及其对腔内修复术患者主动脉重塑的影响. 山东医药, 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. 秦少华, 高学军, 郝庭嘉, 等. 单分支支架治疗锚定区不足Standford B型主动脉夹层. 中国血管外科杂志(电子版), 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, 符伟国, 王玉琦, 等. 胸主动脉腔内修复扩展近端锚定区的探讨. 中华外科杂志, 2005, 43(13): 857-860.
11. Riambau V, Böckler 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. 陆清声, 景在平. 开窗移植物腔内隔绝术治疗胸主动脉夹层动脉瘤. 中华普通外科杂志, 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. 陈菲, 邵娟娟, 贾明, 等. 全胸腹主动脉置换术后脊髓缺血的临床分析. 心肺血管杂志, 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

一体化单分支型主动脉支架腔内修复Stanford B型主动脉夹层的疗效体会

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content