摘要
目的探讨应用Castor分支型主动脉覆膜支架治疗健康锚定区不足15 mm的Stanford B型主动脉夹层(TBAD)的临床效果。方法回顾性分析解放军第九七〇医院2017年10月至2018年6月应用Castor单分支型支架治疗18例近端健康锚定区<15 mm的TBAD患者的临床资料,其中急性TBAD 17例,慢性TBAD 1例,患者均经CT血管成像(CTA)确诊。结果手术成功率100%,手术平均时间(127.8±20.1)min,均无内漏发生,围术期无脑梗死、夹层动脉瘤破裂等并发症,无死亡病例。术中2例左锁骨下动脉(LSA)分支支架释放后存在狭窄,给予球囊扩张后狭窄解除;1例术后出现左侧肱动脉穿刺点血肿,经保守治疗治愈。随访18例,平均随访时间(8±2)个月,无截瘫及死亡病例,LSA分支支架通畅率为100%,无内漏及夹层逆撕,胸主动脉段真腔直径较术前明显扩大、假腔直径较术前明显缩小(P<0.05),胸段假腔术后血栓化率高于腹主动脉。结论 Castor分支型覆膜支架治疗近端健康锚定区不足15 mm的TBAD可以有效重建LSA,操作安全精准,隔绝效果好,短期随访无内漏发生,远期疗效尚需进一步观察。
Objective To investigate the clinical effect of Castor branched stent-graft in the treatment of Stanford B aortic dissection (TBAD) with healthy landing zone less than 15 mm. Methods The clinical data of 18 patients with TBAD (proximal healthy landing zone< 15 mm) treated with Castor branched stent-graft from October 2017 to June 2018 were retrospectively analyzed, including 17 patients with acute TBAD and 1 patient with chronic TBAD. All patients were diagnosed by computed tomography angiography (CTA). Results The success rate of operation was 100%. The mean operation time was (127.8±20.1) minutes. There was no endoleak. During the perioperative period, no complications such as death, stroke and dissecting aneurysm rupture occurred. Branched stent stenosis occurred in 2 cases after branched stent implanted,and relieved by balloon dilatation. Brachial artery puncture point hematoma occurred in 1 case and recovered after conservative treatment. 18 cases (100%, 18/18) were followed up with an average of(8±2)months. No paraplegia and death occurred. The patency rate of LSA branched stent was 100%, no endoleak or retrograde dissection occurred, and the true lumen diameter was significantly increased while the false lumen diameter was significantly decreased compared with their preoperative values (P<0.05), the false lumen thrombosis rate of the thoracic aorta was higher than that of the abdominal aorta. Conclusion Castor branched stent-graft is a safe and feasible option for TBAD with healthy landing zone less than 15 mm during thoracic endovascular aortic repair.
作者
秦少华
高学军
郝庭嘉
战激光
张杰
逄晓军
赵堂海
QIN Shao-hua;GAO Xue-jun;HAO Ting-jia;ZHAN Ji-guang;ZHANG Jie;PANG Xiao-jun;ZHAO Tang-hai(Graduate school, Binzhou Medical University, Yantai 264000, China;Department of Thoracic Surgery, Affiliated Hospital of Binzhou Medical University, Yantai 264000,China;Department of Vascular Surgery, The 970 th Hospital of PLA, Yantai 264000, China)
出处
《中国血管外科杂志（电子版）》
2019年第1期28-32,36,共6页
Chinese Journal of Vascular Surgery(Electronic Version)
关键词
夹层
主动脉腔内修复术
分支支架
左锁骨下动脉
Dissection
Thoracic endovascular aortic repair
Branched stent
Left subclavian artery
