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目的总结应用血管腔内修复术治疗主动脉弓降部病变的初步经验。方法 2007年7月至2011年9月福建医科大学附属协和医院心血管外科对33例主动脉弓降部病变患者实施血管腔内修复术(endovascular aneurysm repair,EVAR)治疗,其中男性24例,女性9例,年龄28～81(61.3±19.5)岁,包括累及弓部分支的B型主动脉夹层19例,主动脉弓降部真性动脉瘤7例,主动脉弓降部假性动脉瘤3例,主动脉弓穿透性溃疡3例,主动脉食管瘘1例。所有患者均实施了血管腔内修复,其中12例先进行解剖外旁路手术,16例1期直接覆盖左锁骨下动脉,2例使用覆膜支架近端开槽技术保留左锁骨下动脉,3例使用“烟囱”技术重建左锁骨下动脉或左颈总动脉。结果全组均取得技术成功。术后1例因脑梗塞伴肺炎、肾功能衰竭不治,其余均痊愈出院。30例随访2～52个月,均恢复正常生活。3例出现头晕等窃血表现,在1个月内缓解。术后随访CT血管造影(computerized tomographic angiography,CTA)示:主动脉支架无移位,6例原有内漏已消失,无新的内漏发生,夹层假腔或动脉瘤腔内已有血栓形成,远端夹层假腔无明显扩大,旁路人工血管及“烟囱”支架通畅。结论应用血管腔内修复术治疗主动脉弓降部病变有满意的近期疗效,是治疗此类病变的重要方法。
Objective To summarize the experience of using endovascular repair in the treatment of aortic arch lesion. Methods From July 2007 to September 2011, 33 cases of aortic arch lesion were treated by endovascular aneurysm repair (EVAR) in cardiovascular surgery of Union Hospital, Fujian Medical University. There were 24 males and 9 females , Aged 28-81 years (61.3 ± 19.5 years), including 19 cases of type B aortic dissection involving the arch of the arch, 7 cases of true aortic aneurysm in the arch of the aorta, 3 cases of pseudoaneurysm of the descending aorta, 3 cases of aortic arch penetrating ulceration 3 cases, 1 case of aortic esophageal fistula. Endovascular repair was performed in all patients. Twelve of the patients underwent primary anatomical bypass surgery. Sixteen patients underwent primary left subclavian artery immediately. Two patients underwent left subclavian artery occlusion using proximal stent-graft technique. 3 Example To reconstruct left subclavian artery or left common carotid artery using “Chimney” technique. Results All groups achieved technical success. One case of postoperative cerebral infarction with pneumonia, renal failure died, the rest were cured. 30 cases were followed up for 2 ~ 52 months, all return to normal life. 3 cases of dizziness and other steal performance, relieved within 1 month. Postoperative follow-up of CT angiography (computerized tomographic angiography, CTA) showed: no displacement of the aortic stent, 6 cases of the original internal leakage has disappeared, no new endoleak occurred, false intracavitary or aneurysm cavity has thrombosis , No significant expansion of the distal dissection foramen, bypassing artificial blood vessels and “chimney ” stent patency. Conclusion Endovascular repair of aortic arch lesion with satisfactory short-term curative effect is an important method for the treatment of such lesions.