中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

头臂血管转流并主动脉覆膜支架植入术在 Stanford B1C 型主动脉夹层中的应用

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目的 评价头臂血管转流并主动脉覆膜支架植入术治疗 Stanford B1C 型主动脉夹层的治疗效果。 方法 自 2013 年 12 月至 2017 年 12 月期间我中心应用头臂血管转流并同期行覆膜支架植入手术技术治疗 Stanford B1C 型主动脉夹层患者 49 例,其中男 33 例、女 16 例,平均年龄(60.4±5.5)岁,29 例实施左颈总动脉-左锁骨下动脉人工血管转流术,18 例实施右颈总动脉-左颈总动脉-左锁骨下动脉人工血管转流术,2 例实施右颈总动脉-右锁骨下动脉转流+左颈总动脉-左锁骨下动脉人工血管转流术。 结果 全组患者术后 30 d 内死亡 1 例(2.0%),术后生存 48 例,随访率 100%(48/48),术后随访 6~47(26.8±11.9)个月,其中 1 例术后 6 个月再发胸痛,急诊复查全程主动脉血管造影 CT 提示 Stanford A 型主动脉夹层,行外科手术,效果满意,全组存活患者未发生内漏。 结论 头臂血管转流并同期进行主动脉覆膜支架植入手术治疗 Stanford B1C 型主动脉夹层患者是安全有效的。

Objective To evaluate the initial results of a hybrid procedure for treating Stanford type B1C aortic dissection. Methods In our center, 49 patients with Stanford type B1C aortic dissection underwent a hybrid procedure, namely, thoracic endovascular aortic repair (TEVAR) combined with supra-arch branch vessel bypass from December 2013 to December 2017. There were 33 males and 16 females with an average age of 60.4±5.5 years. Left common carotid artery to left subclavian artery bypass (n=29), right common carotid artery to left common carotid artery and left subclavian artery bypass (n=18), left common carotid artery to left subclavian artery and right common carotid artery to right subclavian artery bypass (n=2) were performed. Results Early mortality rate was 2.0% (1/49). Forty-eight patients survived postoperatively. The follow-up rate was 100% (48/48). The conditions of patients were followed up for 6 to 47 (26.8±11.9) months postoperatively. One patient of chest pain repeated 8 months after the operation. The whole aorta CTA was diagnosed with the type A1S aortic dissection, and the operation was satisfactory.There was no endoleak and paraplegia. Conclusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for type B1C aortic dissection.

关键词: Stanford B1C 型主动脉夹层; 头臂血管转流; 杂交手术; 覆膜支架

Key words: Type B1C aortic dissection; supra-arch branch vessel bypass; hybrid procedure; stent graft

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