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多枚平行支架重建弓上分支全腔内修复主动脉弓部疾病的手术疗效分析 |
郭宝磊1,2, 符伟国1, 郭大乔1, 徐欣1, 陈斌1, 史振宇1, 董智慧1, 严诚3
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1.复旦大学附属中山医院血管外科, 复旦大学血管外科研究所, 国家放射与治疗临床医学研究中心, 上海 200032;2.上海浦东复旦大学张江科技研究院, 上海 201203;3.复旦大学附属中山医院放射科, 上海 200032
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摘要: |
目的 探讨应用多枚平行支架技术重建弓上分支全腔内修复主动脉弓部疾病的短中期疗效。方法 分析2011年2月至2018年8月复旦大学附属中山医院血管外科收治的因高危不耐受开放手术采用多枚平行支架联合胸主动脉腔内修复术治疗的27例主动脉弓部疾病患者的临床资料。结果 男20例,女7例,平均年龄(50.8±10.1)岁。27例患者中包括胸主动脉瘤10例,B型主动脉夹层伴弓部逆撕7例,胸主动脉腔内修复术后Ⅰ型内漏4例,A型夹层术后远端弓部动脉瘤3例,吻合口假性动脉瘤3例。主动脉弓部病变累及Z0区17例,累及Z1区10例。手术技术成功率100%。术中Ⅰ型内漏10例(37.0%),围手术期无重大不良事件和死亡。中位随访时间为24.2个月(3~92个月),随访期间因主动脉相关并发症再干预3例。总死亡率11.1%(3/27)。估计2年和4年的总体生存率分别为92.4%±5.6%和83.2%±11.7%。估计2年和4年免于内漏发生率分别为84.4%±9.4%和75.9%±14.1%。结论 对不适合开放手术的高危患者,采用多枚平行支架重建弓上分支全腔内修复主动脉弓部疾病的短中期疗效满意。远期结果有待更大样本的进一步长期随访和观察。 |
关键词: 动脉瘤 主动脉夹层 平行支架 腔内治疗 |
DOI:10.12025/j.issn.1008-6358.2022.20220145 |
分类号:R543.1+6 |
基金项目:国家自然科学基金(82000436),上海市科学技术委员会"科技创新行动计划"项目(201409004800,21410710500),上海市卫生健康委员会卫生行业临床研究专项(20214Y0274),复旦张江临床医学创新基金项目(KP7202116). |
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Outcomes of endovascular repair of aortic arch disease with multiple parallel stent grafts |
GUO Bao-lei1,2, FU Wei-guo1, GUO Da-qiao1, XU Xin1, CHEN Bin1, SHI Zhen-yu1, DONG Zhi-hui1, YAN Cheng3
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1.Department of Vascular Surgery, Zhongshan Hospital, Fudan University, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China;2.Fudan Zhangjiang Institute, Shanghai 201203, China;3.Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Abstract: |
Objective To explore the early and midterm outcomes of treating aortic arch disease with multiple parallel stent grafts (MPSGs) in patients deemed high risk for open surgery. Methods To analyze the clinical data of 27 patients with aortic arch diseases treated by multiple parallel stents combined with thoracic aortic endovascular repair in the Department of Vascular Surgery of Zhongshan Hospital, Fudan University from February 2011 to August 2018. Results A total of 27 patients (mean age,[50.8±10.1] years; 20 men) underwent TEVAR with MPSGs. Pathologies included thoracic aortic aneurysm (n=10), type B aortic dissection with retrograde dissection (n=7), post-TEVAR type Ⅰ endoleak (n=4), aortic arch dissected aneurysm postsurgical repair (n=3), and anastomotic pseudoaneurysm (n=3). Seventeen and ten patients had disease in aortic arch zone 0 and 1, respectively. Technical success was achieved in all patients. Intraoperative type Ⅰ endoleak was observed in 10 patients (37.0%). No major morbidity or mortality occurred perioperatively. The median follow-up duration was 24.2 months (range, 3-92), during which time 3 patients required an aortic-related reintervention. The overall mortality rate was 11.1% (3/27). The estimated 2- and 4-year survival rates were 92.4% ±5.6% and 83.2% ±11.7%, respectively. The estimated rates of freedom from endoleak at 2 and 4 years were 84.4% ±9.4% and 75.9% ±14.1%, respectively. Conclusions TEVAR with MPSGs is feasible for the treatment of aortic arch disease in high-risk patients unsuitable for open surgery. Additional evidence and studies with larger sample size and longer follow-up are required to standardize this technique and support its durability. |
Key words: aneurysm aortic dissection parallel stent endovascular repair |