胸主动脉病变覆膜支架并“烟囱

胸主动脉病变覆膜支架并“烟囱"技术疗效分析

樊开凯,魏民新,付强,王赞鑫

天津医科大学总医院

收稿日期:2013-09-22 修回日期:2013-11-21 出版日期:2014-04-15 发布日期:2014-04-15
通讯作者: 魏民新

The Application of Chimney Technique in Thoracic Endovascular Aortic Repair of Thoracic Aortic Lesions

¹,Minxin Wei ³

Received:2013-09-22 Revised:2013-11-21 Published:2014-04-15 Online:2014-04-15
Contact: Minxin Wei

樊开凯,魏民新,付强,王赞鑫. 胸主动脉病变覆膜支架并“烟囱"技术疗效分析[J]. .

¹,Minxin Wei ³. The Application of Chimney Technique in Thoracic Endovascular Aortic Repair of Thoracic Aortic Lesions[J]. .

摘要/Abstract

摘要： 【摘要】目的探讨胸主动脉覆膜支架并“烟囱”技术在近端锚定区不足时左锁骨下动脉（LSA）、左颈总动脉（LCCA）的处理方法及疗效。方法回顾分析近年收治的近端锚定区不足的21例胸主动脉病变患者（B型夹层11 例，假性动脉瘤2例，动脉瘤1例，穿透性溃疡7例），18例病变位于LSA开口远侧，距LSA锚定区＜15mm，3例病变破口位于LSA与LCCA之间。采用胸主动脉覆膜支架并LSA或LCCA“烟囱”技术治疗，观察脑及上肢缺血并发症发生情况。术后评价支架内漏、LSA或LCCA显影等。结果 21例患者均成功地在主动脉内植入覆膜支架，“烟囱”支架同时分别植入在LSA18例，LCCA3例。术后患者均未出现神经系统并发症及左上肢严重缺血症状。术后随访1～ 38个月，主动脉覆膜支架形态良好，未发现Ⅰ型内漏，“烟囱”支架内血流通畅。结论胸主动脉病变近端锚定区不足时，“烟囱”技术可延长锚定区并保持LSA或LCCA通畅，更为安全地拓展了胸主动脉病变腔内治疗的适应证，达到了微创、安全、有效的目的。

关键词: “烟囱”技术, 主动脉夹层, 左锁骨下动脉, 近端锚定区

Abstract:

[Abstract] Objective To evaluate the feasibility of strent-graft with Chimney technique in thoracic endovascular aortic repair (TEVAR) of thoracic aortic dissection left subclavian artery (LSA) disease and left common carotid artery (LCCA) disease without good landing zone. Methods A total of21patients with thoracic aortic diseases complicated by in? sufficient proximal anchoring area，who were presented in our hospital in recent years，were selected in this study. The clini? cal data were retrospectively analyzed. The thoracic aortic diseases included aortic dissection (n=11), aortic pseudoaneurysm (n=2), aortic aneurysm(n=1) and penetrating ulcer(n=7). Among all 21patients，lesion was located in distal to LSA in 18pa? tients with distance to LSA anchoring less than15mm,and the lesion was located between the LSA and LCCA in the rest3 patients．Thoracic aortic stent-graft placement was carried out．The ostium of LSA was intentionally and completely cov? ered by thoracic aortic stent-graft and left subclavian artery or left internal carotid artery stent-graft placement was subse? quently performed．The patients were observed for symptoms of cerebral and upper limb ischemia. The postoperative com? plications such as endoleak and the patency of LSA were assessed with angiography.Results Thoracic aortic stent-graft placement was suceessfully carried out in all21patients. In addition，one“Chimney”stent was properly implanted in LSA or LICA in each patient．After the procedure，no complications of nervous system or severe ischemia of upper extremity was observed．Follow-up examinations between to38months after the treatment revealed that the aortic stent-graft remained in stable condition without type I endoleak. Meanwhile the blood flow in“chinney”stent was unobstructed. Conclusion Chimney technique can expand the applicability of TSGP with high tolerance. Chimney technique expand the applicability of TEVAR for patients with challenging anatomy. It is a safe，effective and microinvasive method to treat thoracic aortic lesions.

Key words: Chimney technique, Aortic dissection, Left subclavian artery, Proximal anchoring area

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