摘要
目的:评价局麻下经皮穿刺血管缝合器预留方法行主动脉腔内隔绝术的安全性和可靠性。方法:30例主动脉夹层(Stanford B型)患者经降压及控制心率治疗后,在局麻下经皮穿刺股动脉,预留两把血管缝合器,经股动脉送入大动脉覆膜支架至降主动脉,精确定位后在临时心脏起搏下释放支架,术后缝合血管,观察术后穿刺部位有无血肿、出血、假性动脉瘤等并发症情况。结果:28例患者为局麻下手术,仅2例患者因不配合而在全麻下手术治疗。所有患者均成功缝合,1例患者使用了3把血管缝合器,1例患者因主动脉夹层累及右股动脉而从左股动脉途径手术。9例患者因破口距离左锁下动脉近且左椎优势而行烟囱支架术。1例患者因破口大,置入2枚大动脉覆膜支架。所有患者术后常规右下肢制动6~8 h。术后穿刺处均未见出血、假性动脉瘤,无动静脉瘘及腹膜后血肿情况,2例患者穿刺部位有血肿,行压迫后消失。穿刺处未见感染。所有患者术后3~7 d均好转出院。结论:局麻下经皮穿刺血管缝合器预留主动脉腔内隔绝术是一种安全可行的方法。
Objective: To evaluate the safety and effectivenes of percutaneous endovascular aortic repair with preclose technique using a vascular closure device under local anesthesia. Methods: Thirty patients with aortic dissection(Stanford B type)were treated in our department. After treatment of hypotension and heart rate control, femoral artery was percutaneously punctured under local anesthesia. Two suture devices were reserved and transported to the descending aorta via femoral artery covered stent. After precise positioning, they were subjected to temporary cardiac pacing. Release stent, suture blood vessel after operation, observe the complications such as hematoma, bleeding and pseudoaneurysm at puncture site after operation. Results: 28 cases were operated under local anesthesia, only 2 cases were operated under general anesthesia because of non-cooperation. All patients were sutured successfully. One patient used three sutures and one patient underwent left femoral artery surgery because aortic dissection involved the right femoral artery. Chimney stenting was performed in 9 patients because of the proximity of the rupture to the left subclavian artery and the superiority of the left vertebra. In one case, two large artery covered stents were implanted because of the large rupture. All patients were braked for 6~8 hours after operation. No bleeding, pseudoaneurysm, arteriovenous fistula and retroperitoneal hematoma were found at the puncture site. Two patients had hematoma at the puncture site and disappeared after compression. No infection was found at the puncture site. All patients were discharged from hospital 3~7 days after operation. Conclusions: Percutaneous endovascular aortic repair with preclose technique using a vascular closure device was a good choice.
作者
廖祥中
陈朝晖
谢东明
LIAO Xiang-zhong;CHEN Zhao-hui;XIE Dong-ming(Department of Cardiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi 341000)
出处
《赣南医学院学报》
2019年第8期776-778,共3页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
关键词
主动脉夹层
腔内隔绝术
血管缝合器
aortic dissection
percutaneous endovascular aortic repair
vascular suture
