亚洲外科手术病例研究  >> Vol. 3 No. 4 (December 2014)

开槽带分支覆膜支架在弓部胸主动脉夹层中的应用
The Use of Branch with Slot Coated Stent in the Treatment of Complex Thoracic Aortic Dissection

DOI: 10.12677/ACRS.2014.34004, PDF, HTML,  被引量 下载: 2,295  浏览: 7,555 

作者: 黄建华, 李 刚, 刘晓蕾, 刘光强, 欧阳洋, 王宪伟, 王 伟:湘雅医院血管外科,中南大学,长沙

关键词: 复杂胸主动脉夹层血管腔内治疗开槽带分支覆膜支架Complex Thoracic Aortic Dissection Endovascular Abdominal Aortic Aneurysm Repair Branch with Slot Coated Stent

摘要: 目的:探讨开槽带分支覆膜支架在弓部胸主动脉夹层中的应用的价值。方法:2012年10月~2012年12月,对2例弓部胸主动脉夹层采用血管腔内治疗技术(EVAR)治疗。对于弓部胸主动脉夹层,破口接近左锁骨下动脉、颈总动脉,不适于标准的腔内修复,我们采用的方法是开槽带分支胸主动脉覆膜支架植入术。切开股动脉穿刺置入导丝进入胸主动脉;另外,左侧肱动脉穿刺置入另一根导丝到左锁骨下动脉、降主动脉、胸主动脉,并从股动脉的切口引出;通过股动脉的两根导丝置入修复胸主动脉夹层的开槽带分支的覆膜支架主体和分支支架到达预定位置;然后,从无名动脉预置的导管造影,明确分支确实位于左锁骨下动脉中,再相继释放分支支架和主体支架。结果:2例手术全部获成功。腔内治疗最后的造影显示:胸主动脉夹层破口封堵良好,左锁骨下动脉、颈总动脉血流正常。术中2例均无内漏。结论:对于不适宜行传统治疗的弓部胸主动脉夹层,开槽带分支覆膜支架是传统EVAR技术的有效补充。远期效果尚需进一步观察。
Abstract: Objective: To research the use of branch with slot coated stent for endovascular exclusion in the treatment of complex thoracic aortic dissection. Methods: Totally 2 patients with complex thoracic aortic dissection were treated by EVAR (Endovascular Aneurysm Repair) with branch slot coated stents between Oct. 2012 to Dec. 2012 at our department. Because the bow of thoracic aortic dis-section and the crevasse are close to the left subclavian artery and common carotid artery which are unsuitable for standard EVAR, we choose EVAR with branch slot coated stent. During the procedure, by femoral artery incision, we introduced a guide wire through the thoracic aorta and another guide wire through the left brachial artery to reach the left subclavian artery, descending aorta, thoracic aorta and eliciting it from the femoral artery incision. And then, the main stent was placed through the guide wire in the thoracic aorta and the branch stent was placed through the guide wire in the left subclavian artery. Then make an angiography from the unknown artery puncture to make sure the placement of the stent is right, and release the main stent and the branch stent subsequently. Results: The success rate of the procedure was 100%. Angiography at the end of the operation showed normal blood flow into the left subclavian artery, common carotid artery and the crevasse of thoracic aortic dissection was well-separated. There is no inner leakage in the two cases. Conclusion: Branch slot coated stent is an effective supplement of conventional EVAR which is unsuitable for patients with complex thoracic aortic dissection. Further study is necessary to observe its long-term outcomes.

文章引用: 黄建华, 李刚, 刘晓蕾, 刘光强, 欧阳洋, 王宪伟, 王伟. 开槽带分支覆膜支架在弓部胸主动脉夹层中的应用[J]. 亚洲外科手术病例研究, 2014, 3(4): 17-22. http://dx.doi.org/10.12677/ACRS.2014.34004