CAJ | 학술논문

目的设计制作新型一体化带单分支的主动脉腔内支架,以此种支架对动物行主动脉弓分支区腔内血管重建的实验,探讨其腔内重建主动脉弓的可行性.方法设计并制作适合于动物实验的一体化单分支覆膜支架,其分支针对左锁骨下动脉(LSA)；在X线透视引导下,对猪行主动脉弓腔内血管重建；术后第3个月观察支架形态结构、主动脉血流动力学变化及内漏发生状况.结果 8例均完成支架的植入,平均手术时间(93.5±12.1)min；术后第3个月造影显示支架位置及形态良好,冠状动脉及分支动脉血流通畅,未发现支架贴壁不良的情况；头部CT未发现脑梗塞；支架植入后第3个月,LSA的血压为(138.0±8.8) mm Hg(1 mm Hg =0.133 kPa),降主动脉的动脉压为( 141.3±8.5) mmHg,与术前比较差异均无统计学意义(P＞0.05)；对支架周围的血管壁组织切片检查未发现血管内膜损伤.结论应用一体化单分支支架部分重建猪的主动脉弓在技术上可行,有助于探索腔内重建人体主动脉弓.
목적 설계제작신형일체화대단분지적주동맥강내지가,이차충지가대동물행주동맥궁분지구강내혈관중건적실험,탐토기강내중건주동맥궁적가행성.방법 설계병제작괄합우동물실험적일체화단분지복막지가,기분지침대좌쇄골하동맥(LSA)；재X선투시인도하,대저행주동맥궁강내혈관중건；술후제3개월관찰지가형태결구、주동맥혈류동역학변화급내루발생상황.결과 8례균완성지가적식입,평균수술시간(93.5±12.1)min；술후제3개월조영현시지가위치급형태량호,관상동맥급분지동맥혈류통창,미발현지가첩벽불량적정황；두부CT미발현뇌경새；지가식입후제3개월,LSA적혈압위(138.0±8.8) mm Hg(1 mm Hg =0.133 kPa),강주동맥적동맥압위( 141.3±8.5) mmHg,여술전비교차이균무통계학의의(P＞0.05)；대지가주위적혈관벽조직절편검사미발현혈관내막손상.결론 응용일체화단분지지가부분중건저적주동맥궁재기술상가행,유조우탐색강내중건인체주동맥궁.
Objective To design a novel unifurcate stent graft and evaluate the feasibility of endovascular repair in pigs using this stent graft for the descending aorta and the left subclavian artery (LSA).Methods Unifurcate-covered stents were implanted in 8 pigs for the experiments by endovascular method.Arteriography,head computed tomography (CT) scans and animal autopsy were performed 3 months after the procedures.The pre- and postoperative arterial blood pressure in descending aorta and LSA in each animal was measured 3 months after stent graft deployment.Results Unifurcate stent graft was deployed successfully in each animal.The mean operation time was (93.5 ± 12.1 ) min.All animals survived for at least 3 months.The biological characters of the experimental animals were as usual.Arteriography and necropsy revealed good fixation in all cases.None of the animals displayed backflow through the aortic valve,and their coronary ostia appeared uncompromised.The head CT scans found no lesion of cerebral infarction.The arterial pressure in LSA was (138.0 ±8.8) mm Hg (1 mm Hg=0.133 kPa) and the arterial pressure in descending aorta was ( 141.3 ± 8.5 ) mm Hg.There was no significant difference in arterial pressure in descending aorta and LSA before and after operation ( P ＞ 0.05 ).The statistical results were not supposed to cause any serious ischaemia of the upper extremities.Conclusion Endovascular repair of the aortic arch by side branched stent graft system seems to be feasible and safe.Further studies are required before clinical application of this procedure.