不同方式重建左锁骨下动脉用于锚定区不足主动脉夹层的效果评价

Evaluation of Left Subclavian Artery Reconstruction in Different Ways for Aortic Dissection with Insufficient Anchorage Area

摘要: 目的：探究不同方式重建左锁骨下动脉用于锚定区不足主动脉夹层的效果。方法：选取2020年10月~2022年3月我院收取的锚定区不足主动脉夹层42例。按照重建方式不同，将患者分为烟囱组、Castor支架组，各21例。烟囱组患者应用烟囱技术进行重建、Castor支架组患者应用Castor支架技术进行重建。分析两组患者围手术期情况，比较两组管腔直径、管腔面积，评估血栓化率，记录术后不良情况。结果：相较烟囱组，Castor支架组腹主动脉假腔部分部分血栓化率较低，完全血栓化率较高(P < 0.05)，2组手术成功率、手术用时、支架变形率、住院时长及内漏发生率等围术期指标比较差异无统计学意义(P > 0.05)；2组在左锁骨开口面、气管隆突面、膈肌面及肾动脉开口上缘面4个平面上主动脉真腔管径差值、主动脉真腔面积差值及假腔面积差值、假腔腔管径差值比较(P > 0.05)。两组术后不良情况比较，Castor支架组术后不良情况较低(P < 0.05)。结论：在主动脉腔内修复术治疗锚定区不足主动脉夹层患者中，应用Castor支架技术相比烟囱技术的重建方式，Castor支架技术内漏发生率较低，效果较好。

Abstract: Objective: To explore the effect of different ways of reconstruction of left subclavian artery for aortic dissection with insufficient anchorage area. Methods: We selected 42 cases of insufficient aortic dissection in the anchoring region charged by our hospital from October 2020 to March 2022. The patients were divided into the stack group, the castor stent group, 21 patients each, according to the mode of reconstruction. Patients in the stack group were reconstructed with the stack tech-nique, and patients in the castor stent group were reconstructed with the stack technique. The perioperative conditions of the two groups were analyzed, and the lumen diameter and lumen area were compared between the two groups, to evaluate the thrombotic rate and record the postopera-tive adverse conditions. Results: Compared with the stack group, the castor stent group showed a lower rate of partial thrombosis and a higher rate of complete thrombosis in the false lumen portion of the abdominal aorta (P < 0.05), while the 2 groups showed no significant differences in perioper-ative indicators such as procedure success, procedure duration, stent deformation rate, hospital stay and incidence of internal leakage (P > 0.05); In group 2, the differences in the diameter of the true lumen of the aorta, the difference in the area of the true lumen of the aorta and the difference in the area of the false lumen between the 2 groups in 4 planes including the plane of the left clavic-ular opening, the plane of the tracheal carina, the plane of the diaphragm and the upper border of the renal artery opening were statistically significant (P > 0.05). Postoperative adverse events were lower in the castor stent group when compared between the two groups (P < 0.05). Conclusion: Compared with the reconstruction method of chimney technology, castor stent technology has a lower incidence of internal leakage and better effect in the treatment of aortic dissection with insuf-ficient anchoring area by endovascular repair.