自显影体外开窗、烟囱与Ⅳb型杂交技术在胸主动脉腔内修复术中重建左锁骨下动脉效果的对比研究
Comparison of self-radiopaque markers guiding physician-modified fenestration,chimney technique and hybrid Ⅳb technique on reconstruction of left subclavian artery in thoracic endovascular aortic repair
翟浠烨 1舒畅 2张译丹 1范博文 1韩辉 1田川 1方坤 1罗明尧3
作者信息
- 1. 中国医学科学院北京协和医学院阜外医院血管外科中心 国家心血管病中心 心血管疾病国家重点实验室,北京 100037
- 2. 中国医学科学院北京协和医学院阜外医院血管外科中心 国家心血管病中心 心血管疾病国家重点实验室,北京 100037;中南大学湘雅二医院血管外科,长沙 410011;阜外华中心血管病医院血管外科,郑州 450046
- 3. 中国医学科学院北京协和医学院阜外医院血管外科中心 国家心血管病中心 心血管疾病国家重点实验室,北京 100037;阜外华中心血管病医院血管外科,郑州 450046;云南阜外心血管病医院血管外科,昆明 650102
- 折叠
摘要
目的 对比自显影体外开窗、烟囱与Ⅳb型杂交技术在胸主动脉腔内修复术中重建左锁骨下动脉的效果.方法 回顾性分析中国医学科学院阜外医院2016年1月至2019年12月312例行胸主动脉腔内修复术并重建左锁骨下动脉血供患者的临床及随访资料.结果35例为Ⅳb型杂交血管搭桥组,93例为烟囱组,184例为体外开窗组.随访时间12～24个月.所有患者随访期间均未出现人工血管及支架闭塞,左锁骨下动脉血流通畅.19例患者在末次随访时存在内漏,三组间差异无统计学意义(P＞0.05).11例患者进行了再干预手术治疗,均为烟囱组及体外开窗组患者,但差异无统计学意义(P＞0.05).住院期间,28例患者出现并发症,其中搭桥组院内并发症发生率最高(P＜0.01).随访期间,搭桥组患者4例死亡,体外开窗组6例患者死亡,烟囱组8例患者死亡,差异无统计学意义(P＞0.05).结论 体外开窗和烟囱技术重建左锁骨下动脉血流的安全性和疗效相似,对于左锁骨下动脉的血流重建效果确切,早期并发症低于Ⅳb型杂交技术,但内漏再干预率高.
Abstract
Objective To compare the effect of self-radiopaque markers guiding physician-modified fenestration,chimney technique and hybrid Ⅳ b technique on reconstruction of left subclavian artery(LSA)in endovascular treatment of aortic dissection(TEVAR).Methods The clinical and follow-up data of 312 TEVAR patients treated with LSA blood supply reconstruction technology from Jan 2016 to Dec 2019 at Fuwai hospital were retrospectively analyzed.Results There were 35 patients in the hybrid Ⅳb technique group,93 in the chimney technique group,and 184 in the in vitro fenestration group.The follow-up period ranged from 12 to 24 months.No artificial blood vessel and stent occlusion occurred in all patients during follow-up,and the LSA blood flow was unobstructed.A total of19 patients had endoleak by the last follow-up,and there was no statistical difference between the three groups.Eleven patients underwent reintervention surgery,all were from chimney technique group and in vitro fenestration group,with no statistical difference(P＞0.05).Severe complications occurred in 28 patients during hospitalization,and the incidence of complications was the highest in the hybrid Ⅳb technique group(P＜0.01).During follow-up,4 patients died in the bypass group,6 died in the external window group,and 8 died in the chimney group,with no significant difference(P＞0.05).Conclusions The safety and efficacy of the left subclavian artery flow reconstruction by in vitro fenestration and chimney technique were similar.The occurrences of early complications were lower than that of the hybrid Ⅳb technique,but the reintervention rate of endoleak was higher.
关键词
主动脉疾病/支架/自显影体外开窗/烟囱支架/Ⅳb型杂交/左锁骨下动脉Key words
Aortic diseases/Stents/Self-radiopaque markers guiding physician-modified fenestration/Chimney technique/Hybrid Ⅳb technique/Left subclavian artery引用本文复制引用
基金项目
中央高水平医院临床科研业务费(2022-GSP-GG-16)
中央高水平医院临床科研业务费(2023-GSP-RC-13)
云南省科技厅重点研发计划(202403AC100004)
出版年
2024
NETL
NSTL
万方数据