CAJ | 학술논문

目的总结升主动脉-颈动脉旁路联合腔内修复术治疗主动脉弓部病变的经验与体会.方法回顾性分析2002年1月至2013年6月在中山大学附属第一医院血管外科接受升主动脉-颈动脉旁路联合腔内修复术治疗的10例主动脉弓部病变高危患者的临床资料.其中男性9例,女性1例,年龄34 ～71岁,平均年龄(54±14)岁.原发病包括主动脉夹层8例,胸主动脉瘤2例.行正中开胸行升主动脉-无名动脉-左颈总动脉旁路7例,升主动脉-左颈总动脉-左锁骨下动脉旁路3例,同期(5例)或二期[5例,平均间隔(7±4)d]经股动脉植入覆膜支架修复主动脉弓病变.结果全部手术取得技术成功.术后30 d死亡3例,1例死于脑干梗死,1例死于循环衰竭,1例死于主动脉气管瘘.术后发生Ⅱ型内漏1例.随访1 ～ 132个月,中位随访时间24个月(四分位数间距14个月),术后1个月、3个月、1年及其后每年复查CT,随访期间7例患者均健康存活、人工血管旁路通畅,除1例Ⅱ型内漏继续存在外,其余支架均无移位和内漏.结论升主动脉-颈动脉旁路联合腔内修复术可用于治疗一般情况差、难以耐受主动脉置换的主动脉弓部疾病高危患者.
목적 총결승주동맥-경동맥방로연합강내수복술치료주동맥궁부병변적경험여체회.방법 회고성분석2002년1월지2013년6월재중산대학부속제일의원혈관외과접수승주동맥-경동맥방로연합강내수복술치료적10례주동맥궁부병변고위환자적림상자료.기중남성9례,녀성1례,년령34 ～71세,평균년령(54±14)세.원발병포괄주동맥협층8례,흉주동맥류2례.행정중개흉행승주동맥-무명동맥-좌경총동맥방로7례,승주동맥-좌경총동맥-좌쇄골하동맥방로3례,동기(5례)혹이기[5례,평균간격(7±4)d]경고동맥식입복막지가수복주동맥궁병변.결과 전부수술취득기술성공.술후30 d사망3례,1례사우뇌간경사,1례사우순배쇠갈,1례사우주동맥기관루.술후발생Ⅱ형내루1례.수방1 ～ 132개월,중위수방시간24개월(사분위수간거14개월),술후1개월、3개월、1년급기후매년복사CT,수방기간7례환자균건강존활、인공혈관방로통창,제1례Ⅱ형내루계속존재외,기여지가균무이위화내루.결론 승주동맥-경동맥방로연합강내수복술가용우치료일반정황차、난이내수주동맥치환적주동맥궁부질병고위환자.
Objective To summarize the experience of treating aortic arch disease with ascending aorta to carotid artery revascularization and subsequent endovascular repair.Methods From January 2002 to June 2013,10 high risk patients with aortic arch disease were treated with ascending aorta to carotid artery revascularization with subsequent endovascular repair in the First Affiliated Hospital,Sun Yat-sen University.There were 9 male and 1 female patients with a mean age of (54 ± 14) years (ranging from 34 to 71 years).Of the 10 patients,8 were aortic dissection and 2 were thoracic aortic aneurysm.All aortic arch debranching was performed with mid-sternotomy,including 7 ascending aorta to innominate artery and left common carotid artery bypass,and 3 ascending aorta to left common carotid artery and left subclavian artery bypass.Subsequently,simultaneous (n =5) and staged (n =5,mean interval (7 ± 4) days) endovascular repair were performed via femoral artery.Results Technical success rate was 10/10.The 30 day-mortality was 3/10,including 1 brain stem infarction,1 circulatory failure and 1 aorto-tracheal fistula.Complication included 1 type Ⅱ endoleak.The median time of follow-up was 24 (14) months.CT scanning was performed at 1,3 months and annually thereafter.There was no death and no occlusion of bypass during follow-up.No complication occurred except 1 existing type Ⅱ endoleak.Conclusion Ascending aorta to carotid artery revascularization with subsequent endovascular repair is suitable for high risk aortic arch pathology patients in poor general condition with little tolerance to aortic arch replacement.