CAJ | 학술논문

目的探讨主动脉夹层隔膜穿刺破膜技术治疗覆膜支架误置入夹层假腔的可行性.方法回顾性分析1例Stanford B型主动脉夹层患者,先行主动脉夹层覆膜支架腔内修复术,术后CT血管造影(CTA)发现覆膜支架位于假腔内；后行手术治疗,使用Outback LTD导管在第一支架下方2 cm处的夹层隔膜上戳孔连通真假腔,经破口置入覆膜支架使血流由假腔引回真腔,并行夹层远端破口弹簧圈栓塞. 结果手术在局部麻醉下进行,手术时间170 min,术中出血量约350 ml.术后患者胸背部疼痛症状消失.手术后当天即开始进食、下床活动,未发生截瘫、内脏缺血等并发症.术后1周复查主动脉CTA显示支架位置理想,主动脉及主要内脏动脉血流通畅,假腔影像消失. 结论在覆膜支架远端的夹层隔膜上开窗并置入覆膜支架与第一支架连接,将血流引回真腔,可有效治疗覆膜支架误置入假腔.采用Outback装置进行夹层隔膜的破膜操作,具有定位准确、安全系数高的特点.
목적 탐토주동맥협층격막천자파막기술치료복막지가오치입협층가강적가행성.방법 회고성분석1례Stanford B형주동맥협층환자,선행주동맥협층복막지가강내수복술,술후CT혈관조영(CTA)발현복막지가위우가강내；후행수술치료,사용Outback LTD도관재제일지가하방2 cm처적협층격막상착공련통진가강,경파구치입복막지가사혈류유가강인회진강,병행협층원단파구탄황권전새. 결과 수술재국부마취하진행,수술시간170 min,술중출혈량약350 ml.술후환자흉배부동통증상소실.수술후당천즉개시진식、하상활동,미발생절탄、내장결혈등병발증.술후1주복사주동맥CTA현시지가위치이상,주동맥급주요내장동맥혈류통창,가강영상소실. 결론 재복막지가원단적협층격막상개창병치입복막지가여제일지가련접,장혈류인회진강,가유효치료복막지가오치입가강.채용Outback장치진행협층격막적파막조작,구유정위준학、안전계수고적특점.
Objective To evaluate feasibility of flap fenestration in management of the condition that a stent-graft is wrongly deployed in false lumen of aortic dissection.Methods A retrospective analysis was conducted on a case of Stanford type B aortic dissection who was confirmed that the stent-graft had been wrongly deployed in false lumen of aortic dissection by CT angiography (CTA) after endovascular repair.Thereafter,an additional surgical management was carried out.At length,flap fenestration at 2 cm below pre-deployed stent-graft was performed using an Outback catheter so as to link false and true lumens.Successively,another stent-graft was placed via the access to draw blood flow from false lumen back to true lumen and then coil embolization was performed for distal breach of the dissection.Results Surgery was carried out under local anesthesia,with operation duration of 170 minutes and intraoperative blood loss of 350 ml.The chest and back pain disappeared after operation.The patient commenced to take food and take off-bed activity at the very day of operation in absence of paraplegia,visceral ischemia,or other complications.Aortic CTA at postoperative one week showed ideal positioning of stent-graft,fluent blood flow of aorta and major visceral artery,and vanishing of false lumen.Conclusions Flap fenestration at far-end of pre-deployed stent-graft so as to draw blood flow back to true lumen by connecting the new placed stent graft to pre-deployed stent-graft is an effective treatment for mis-deployment of stentgraft in false lumen of aortic dissection.Outback catheter for flap fenestration is characterized by accurate location and high safety.