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【摘要】目的?探討Castor主動(dòng)脈弓分支型支架治療主動(dòng)脈疾病的有效性和安全性。方法?2013年4月至2014年2月期間，共12例主動(dòng)脈疾病患者接受Castor支架治療，其中主動(dòng)脈夾層9例，胸主動(dòng)脈瘤2例，主動(dòng)脈穿通性潰瘍1例。結(jié)果?手術(shù)成功率為100％，無(wú)I型內(nèi)漏，無(wú)圍手術(shù)期死亡，無(wú)腦卒中、急性心肌梗死、上肢缺血等嚴(yán)重并發(fā)癥，術(shù)后近期隨訪CTA 顯示主動(dòng)脈胸段假腔內(nèi)血栓形成，無(wú)內(nèi)漏。結(jié)論?Castor支架在主動(dòng)脈疾病治療中可以有效重建左側(cè)鎖骨下動(dòng)脈血運(yùn)，無(wú)嚴(yán)重近期并發(fā)癥，遠(yuǎn)期結(jié)果仍需跟蹤多病例的長(zhǎng)期觀察。

【摘要】目的 評(píng)估分支TEVAR技術(shù)治療復(fù)雜主動(dòng)脈弓部病變的近期療效。方法 回顧性分析天津醫(yī)科大學(xué)總醫(yī)院2016年4月至2018年12月應(yīng)用分支TEVAR技術(shù)治療的18例需重建左鎖骨下動(dòng)脈的主動(dòng)脈病變患者的圍手術(shù)期及隨訪資料。結(jié)果 置入Castor外分支支架16例，自制內(nèi)分支支架2例，器械釋放成功率100%，手術(shù)成功率100%，無(wú)術(shù)中死亡病例。術(shù)后并發(fā)癥2例：支架近端逆撕夾層1例（行開(kāi)放手術(shù)）、大面積心梗1例（死亡）。 17例患者獲得隨訪，隨訪時(shí)間1~8個(gè)月。 術(shù)后第30天16例CTA檢查1例發(fā)生III型內(nèi)漏，分支支架血流通暢。術(shù)后6個(gè)月8例CTA檢査無(wú)內(nèi)漏,1例左鎖骨下動(dòng)脈支架遠(yuǎn)端閉塞,予遠(yuǎn)端置入支架解決，無(wú)新發(fā)死亡病例。結(jié)論 分支TEVAR技術(shù)是重建弓上分支動(dòng)脈的有效方法。

【摘要】目的 探討應(yīng)用Castor分支型主動(dòng)脈覆膜支架治療健康錨定區(qū)不足15mm的Stanford B型主動(dòng)脈夾層(TBAD)的臨床效果。方法 回顧性分析解放軍第九七O醫(yī)院2017年10月至2018年6 月應(yīng)用Castor單分支型支架治療18例近端健康錨定區(qū)<15 mm的TBAD患者的臨床資料，其中急性TBAD17例，慢性TBAD1例，患者均經(jīng)CT血管成像(CTA)確診。結(jié)果 手術(shù)成功率100%，手術(shù)平均 時(shí)間(127.8±20.1)min，均無(wú)內(nèi)漏發(fā)生，圍術(shù)期無(wú)腦梗死、夾層動(dòng)脈瘤破裂等并發(fā)癥，無(wú)死亡病例。術(shù)中2例左鎖骨下動(dòng)脈(LSA)分支支架釋放后存在狹窄，給予球囊擴(kuò)張后狹窄解除；1例術(shù)后出現(xiàn)左側(cè)肱動(dòng)脈穿刺點(diǎn)血腫，經(jīng)保守治療治愈。隨訪18例，平均隨訪時(shí)間(8±2)個(gè)月，無(wú)截癱及死亡病例，LSA分支支架通暢率為100%，無(wú)內(nèi)漏及夾層逆撕，胸主動(dòng)脈段真腔直徑較術(shù)前明顯擴(kuò)大、假腔直徑較術(shù)前明顯縮小(P<0.05)，胸段假腔術(shù)后血栓化率高于腹主動(dòng)脈。結(jié)論 Castor分支型覆膜支架治療近端健康錨定區(qū)不足15mm的TBAD可以有效重建LSA，操作安全精準(zhǔn)，隔絕效果好，短期隨訪無(wú)內(nèi)漏發(fā)生，遠(yuǎn)期療效尚需進(jìn)一步觀察。

【摘要】 目的 總結(jié)單分支型主動(dòng)脈支架在Stanford B型主動(dòng)脈夾層的腔內(nèi)隔絕治療經(jīng)驗(yàn)。方法 2013年7月至2014年2月復(fù)旦大學(xué)附屬中山醫(yī)院血管外科對(duì)11例近端破口距離左鎖骨下動(dòng)脈開(kāi)口<20mm的Stanford B型主動(dòng)脈夾層應(yīng)用一體化單分支型主動(dòng)脈支架行腔內(nèi)隔絕治療，觀察術(shù)后即時(shí)血管造影結(jié)果、術(shù)后1個(gè)月門(mén)診隨訪、術(shù)后6個(gè)月行主動(dòng)脈CT血管造影(CTA)檢查。以動(dòng)脈瘤相關(guān)存活率、手術(shù)成功率和分支支架通暢率為有效性終點(diǎn)指標(biāo)，并觀察相應(yīng)的不良事件。結(jié)果 11例中10例術(shù)中支架釋放成功，1例分支支架無(wú)法進(jìn)入左鎖骨下動(dòng)脈而放棄。平均手術(shù)時(shí)間(130.0±36.0)min，圍手術(shù)期無(wú)不良事件。隨訪期10例病人中無(wú)死亡，1例出現(xiàn)支架遠(yuǎn)端內(nèi)漏，1例出現(xiàn)左鎖骨下動(dòng)脈支架閉塞，余支架封堵良好，夾層假腔均出現(xiàn)血栓化，假腔直徑平均縮小12mm。 結(jié)論 單分支型主動(dòng)脈支架對(duì)于近端破口距左鎖骨下動(dòng)脈開(kāi)口<20 mm的Stanford B型主動(dòng)脈夾層是有效的腔內(nèi)隔絕方法。

【摘要】Objective To report the early results of castor device, a kind of unibody single-branched stent graft, in the treatment of type B aortic dissection (TBAD) involving the LSA. Methods From April 2013 to February 2014, 21 patients with TBADs underwent TEVAR with LSA revascularization by unibody single-branched stent grafts. Three patients with penetrating aortic ulcers in the aortic arch received additional reconstruction of left common carotid artery with chimney technique. Follow-up evaluations were conducted with computed tomography angiography (CTA) at 6, 12 months and annually after that. Results All of the proximal entry tears were completely excluded. Good patency of the grafts was found in all cases. A small type I endoleak occurred in one patient during the procedure. Perioperative mortality is null, and there was no occurrence of serious complications. All patients completed the follow-up except one lost contact after discharge. One death occurred within 6 months after the operation, resulting from myocardial infarction, considered unrelated to the stent implantation. No endoleak occurred during follow-up. One compression of a chimney stent and one twist of side branch graft of castor were observed in 2 different patients, respectively. In other cases, CTA scans showed good patency of both the branched and chimney grafts. Two patients had partial thrombosis of the false lumen during follow-up. In other patients, complete thrombosis in the false lumen in thoracic aorta was revealed. Conclusion The single-branched stent graft was safe and efficient in the 1-year follow-up. Further studies are required to determine its long-term outcomes.

【摘要】Background: The present study retrospectively reviewed and evaluated the effectiveness of thoracic endovascular aortic repair (TEVAR) combined with assistant techniques and devices for the treatment of acute complicated Stanford type B aortic dissections involving aortic arch. Methods: Fifty-six patients with acute complicated Stanford type B aortic dissection involving aortic arch were treated with TEVAR combined with hybrid procedure, chimney-graft technique, and branched stent grafts from January 2009 to March 2014. Results: Seventeen patients undergone TEVAR combined with hybrid technique. Technical success was achieved in 94.1% with 5.8% of early mortality. Strokes occurred in a patient developing paraplegia, who completely recovered after lumbar drainage. Cardiocirculatory and pulmonary complications, bypass dysfunction or severe endoleak was not observed. Thirty patients undergone TEVAR combined with chimney technique with 100% technical success rate. Chimney-stent compression was observed in 1 patient, and another bare stent was deployed inside the first one. Three patients (10%) died during the study period. Immediate postoperative type I endoleak was detected in 4 cases (13.3%). TEVAR assisted by Castor branched aortic stent grafts in 9 patients was successful. Mortality during perioperative period and 30 days after TEVAR was null. No serious complications such as strokes, acute myocardial infarction, and ischemia of arms occurred. Conclusions: The results indicate that TEVAR combined with hybrid technique, chimney technique, and branched stent grafts is proven to be a technically feasible and effective treatment for acute complicated Stanford type B aortic dissection involving aortic arch in small cohort.

【摘要】Objective: There is no approved special endovascular device for use in preventing entry tears in the distal part of ascending aorta or in the aortic arch and preserving the arch branch arteries. Thus, we have designed a novel branched stent-graft, and herein report the initial clinical outcomes. Methods: Between August 2009 and January 2014, 51 patients with aortic dissections involving the aortic arch were treated by endovascular branched stent-grafts. There were 7 Stanford type A aortic dissections, 22 retrograde type A aortic dissections, and 22 Stanford type B aortic dissections (including 4 localized aortic arch dissections). All patients were treated while in the chronic phase (>2 weeks). Results: All of the proximal entry tears in the arch were successfully excluded, and all of the treated branch arteries remained patent. No new cerebral infarction occurred. There was 1 death from a retrograde type A dissection, occurring 6 days after the endovascular procedure. The median follow-up period was 44 months (range, 14-66 months). No additional complications or mortality occurred. Complete thrombosis in the false lumen of the aortic arch was formed in all patients, and significant true lumen recovery and false lumen shrinkage were demonstrated in different levels of the thoracic aorta according to computed tomography angiography at 1 year postsurgery (P<.001). Conclusions: In patients with aortic dissection involving the arch branches, the customized branched stent-graft may provide a feasible endovascular treatment option. A larger series of cases with longer follow-up is needed to substantiate these results. (J Thorac Cardiovasc Surg 2015;-:1-8)

【摘要】慢性A型夾層合并Kommerell憩室患者的腔內(nèi)治療依然充滿挑戰(zhàn)，這是我們首次報(bào)道慢性?shī)A層逆撕為A型夾層的腔內(nèi)治療。我們采用一體化單分支支架+煙囪技術(shù)針對(duì)2支鎖骨下動(dòng)脈進(jìn)行重建。術(shù)后造影提示第一破口被完全隔絕，一體化支架及煙囪支架血流通暢，隨訪期間檢查CTA提示真腔顯著重塑。通過(guò)此例患者，我們發(fā)現(xiàn)腔內(nèi)技術(shù)在此類(lèi)患者的治療中是安全和可行的。