[1]李清乐 张韬 张小明** 李伟 张学民 焦洋 何长顺 贺致宾 李伟浩.累及主动脉弓部病变的完全腔内治疗：95例中长期随访结果[J].中国微创外科杂志,2020,01(3):197-211.
　Li Qingle,Zhang Tao,Zhang Xiaoming,et al.Total Thoracic Endovascular Aortic Repair for Lesions Involving Aortic Arch: Mid to Longterm Results of 95 Cases[J].Chinese Journal of Minimally Invasive Surgery,2020,01(3):197-211.
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累及主动脉弓部病变的完全腔内治疗：95例中长期随访结果()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年3期
页码:
197-211
栏目:
临床论著
出版日期:
2020-03-25

文章信息/Info

Title:
Total Thoracic Endovascular Aortic Repair for Lesions Involving Aortic Arch: Mid to Longterm Results of 95 Cases
作者:
李清乐 张韬 张小明** 李伟 张学民 焦洋 何长顺 贺致宾 李伟浩
（北京大学人民医院血管外科，北京100044）
Author(s):
Li Qingle;  Zhang Tao;  Zhang Xiaoming;  et al.
Department of Vascular Surgery, Peking University People’s Hospital, Beijing 100044, China
关键词:
主动脉疾病; 腔内修复术; 开窗支架; 分支支架; 烟囱技术
Keywords:
Aortic disease; Endovascular repair; Fenestrated graft; Branched graft; Chimney technique
文献标志码:
A
摘要:
目的探讨完全腔内技术治疗累及主动脉弓部病变的中长期随访结果。方法回顾性分析2010年1月~2017年12月95例应用完全腔内技术处理累及主动脉弓部病变的临床资料，其中烟囱支架技术81例，“开窗”技术8例（原位4例，体外4例），分支支架技术6例。结果共植入胸主动脉覆膜支架主体95枚，重建主动脉弓部分支动脉124支，其中无名动脉7支，左颈总动脉36支，左锁骨下动脉81支。2例原位开窗失败中转烟囱技术重建分支。术中Ⅰ型内漏11例（116%），其中5例弹簧圈栓塞后消失，6例轻微内漏随访观察。技术成功率91.6%（87/95）。围术期死亡3例（3.2%），一过性截瘫1例（1.1%），脑梗死2例（2.1%），急性心肌梗死2例（2.1%），急性肺损伤1例（1.1%）。存活92例中随访83例，随访率90.2%。1例术后4个月死于脑梗死，1例术后6个月因多器官功能衰竭死亡，其余81例随访时间28~106（58.9±17.9）月，其中73例>36个月。8例因Ⅰ型内漏行二次手术栓塞，未见支架移位、狭窄、闭塞等并发症。结论通过多种完全腔内技术重建各主动脉弓部的分支血管，为累及主动脉弓部病变提供微创治疗机会，中长期随访结果满意。
Abstract:
ObjectiveTo explore the mid to longterm outcomes of total thoracic endovascular aortic repair (TEVAR) of lesions involving the aortic arch.MethodsData of 95 patient receiving TEVAR with supraarch branch endovascular reconstruction from January 2010 to December 2017 were retrospectively collected and analyzed. Perioperative complications and followup outcomes were recorded and analyzed. Methods of branch reconstruction were chimney technique in 81 cases, fenestration in 8 cases (4 in situ and 4 in vitro), and single branched graft in 6 cases.ResultsA total of 95 main stent grafts were implanted, and 124 supraarch branches were reconstructed including 7 innominate artery (IA), 36 left common carotid artery (LCCA), and 81 left subclavian artery (LSA). Two cases were converted to chimney grafts because of insitu fenestration failure. Type Ⅰ endoleak occurred in 11 patients (11.6%), 5 of which were cured after coil embolization and 6 of which had minimal endoleak left for followup observation. The technical success rate was 91.6% (87/95). Postoperative events included 3 deaths (3.2%), 1 transient paraplegia (1.1%), 2 cerebral infarctions (2.1%), 2 acute cardiac infarctions (2.1%), and 1 pulmonary injury (1.1%). Among the 92 survived patients, 83 were followed up, with a followup rate of 90.2%. One patient died of cerebral infarction at 4 months. One patient died of multiorgan function failure at 6 months. The other 81 patients were followed up for 28-106 months with an average period of (589±17.9) months, including 73 patients for more than 36 months. No rupture or aortic related death was determined. Eight patients received reintervention for type Ⅰ endoleak. Based on the followup data analysis, no adverse events were reported, including graft migration, branch stenosis or occlusion.ConclusionTEVAR with total endovascular supraarch branch reconstruction may be a safe and durable strategy for lesions involving the aortic arch in selected patients.

参考文献/References:

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金（81570426）**通讯作者，Email：mailtole@126.com
更新日期/Last Update: 2020-06-19