目的 探讨累及主动脉弓部的主动脉夹层治疗方法.方法 回顾性分析接受胸主动脉腔内修复术(TEVAR)治疗的56例病变累及主动脉弓部的Stanford B型主动脉夹层患者的临床资料.所有患者均经腔内治疗,根据病变部位的不同,分别应用烟囱术及杂交术重建主动脉弓部分支血管.结果 56例患者手术均一期进行,且均获得成功.其中行TEVAR联合左侧锁骨下动脉烟囱术29例,TEVAR联合杂交术27例.术中即刻造影发现Ⅰ型内漏6例,其中2例行顺应性球囊扩张后好转,另外4例未处理.无围手术期死亡病例.随访3~70(22±3)个月,联合行烟囱术及杂交术的患者,分支血管及杂交血管均通畅.结论 对累及主动脉弓部的主动脉夹层患者,在严格做好术前评估、选择合适术式的情况下,结合腔内治疗是安全有效的.
Objective To evaluate the advantages and disadvantages of various methods for the treatment of aortic dissection involving aortic arch. Methods The clinical data of 56 patients with aortic dissection involving aortic arch were analyzed retrospectively. All the patients were treated with throacic endovascular aortic repair (TEVAR) combined with chimney technique and hybrid operation to reconstruct partial vessels of the aortic arch according to the different morphology sites of aortic disease. Results Among 56 patients, 29 cases received TEVAR combined with chimney technique of left subclavian artery, and 27 cases received TEVAR combined with hybrid operation. Six cases had typeⅠendoleak. Among them, 2 cases improved by compliant balloon dilatation, and 4 cases were not treated. There was no death in perioperative period. The patients were followed up for 3-70 (22 ± 3) months, and all the branches of the artery were unobstructed during middle and long term follow-up. Conclusions Combined endovascular treatment is a safe and effective method for aortic dissection involving the aortic arch. In the meantime, strict preoperative evaluation and suitable operation method is also important.