激光原位开窗全腔内修复累及弓部主动脉夹层的临床结果及支架选择标准的单中心经验

doi:10.6040/j.issn.1671-7554.0.2024.320

摘要/Abstract

摘要： 目的报道单中心激光辅助原位开窗技术全腔内修复累及弓部主动脉夹层的临床结果以及支架选择标准的临床经验。方法回顾性分析2016年1月至2023年4月在我院330例接受激光原位开窗腔内修复技术治疗的累及弓部主动脉夹层患者的临床资料,包括患者一般情况、手术操作、技术成功率、手术并发症等内容,总结临床治疗结果,分析主动脉支架及弓部分支动脉重建支架选择标准。结果所有患者均接受了激光原位开窗辅助腔内修复术,手术时间(176±51)min,开窗技术成功率98.1%。院内死亡10例(3.03%),症状性中风8例(2.68%),内漏41例(12.4%),近端支架源性新发破口2例(0.61%),无远端支架源性新发破口。随访CT血管造影(24±7.9)个月,结果显示分支血管通畅率为96.58%。结论激光原位开窗全腔内修复累及弓部主动脉夹层成功率高,并发症发生率低,是安全且有效的方法。

关键词: 主动脉夹层, 主动脉弓部, 激光原位开窗, 腔内修复, 分支重建, 支架

Abstract: Objective To report the clinical outcomes of thoracic endovascular aortic repair with laser in situ fenestration of aortic dissection involving the arch in a single center, and to summarize the clinical experience of stent selection criteria. Methods The clinical data of 330 patients with aortic coarctation involving arch branches treated with thoracic endovascular aortic repair with laser in situ fenestration in our hospital from January 2016 to April 2023 were retrospectively analyzed, including the general information of patients, surgical procedures, technical success rate, and surgical complications. The clinical outcomes were summarized and the selection criteria for aortic stents and branch artery reconstruction stents were analyzed. Results All patients underwent thoracic endovascular aortic repair with laser in situ fenestration, with a mean operation time of(176±51)minutes and a fenestration technique success rate of 98.1%. There were 10 in-hospital deaths(3.03%), 8 symptomatic strokes(2.68%), 41 endoleaks(12.4%), 2 proximal stent-induced new entries(0.61%), and no distal stent-induced new entries were observed. Follow-up CT angiography ［(24±7.9)months］ demonstrated a branch vessel patency rate of 96.58%. Conclusion Laser in situ fenestration with thoracic endovascular repair of aortic dissection involving the arch is a safe and effective technique with a high success rate and a low complication rate.

Key words: Aortic dissection, Aaortic arch, Laser in situ fenestration, Endovascular repair, Reconstruction of branched vessel, Stent

中图分类号:

R654.3

杜国栋, 仇鹏, 刘俊超, 杨心蕊, 吴小雨, 崔超毅, 秦金保, 赵振, 叶开创, 刘光, 刘晓兵, 殷敏毅, 王瑞华, 陆信武. 激光原位开窗全腔内修复累及弓部主动脉夹层的临床结果及支架选择标准的单中心经验[J]. 山东大学学报 (医学版), 2024, 62(9): 86-92.

DU Guodong, QIU Peng, LIU Junchao, YANG Xinrui, WU Xiaoyu, CUI Chaoyi, QIN Jinbao, ZHAO Zhen, YE Kaichuang, LIU Guang, LIU Xiaobing, YIN Minyi, WANG Ruihua, LU Xinwu. Thoracic endovascular aortic repair with laser in situ fenestration of aortic dissection involving the arch: a single-center clinical outcomes and criteria of stent selection[J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 86-92.

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