【摘要】目的 探讨Castor主动脉弓分支型支架治疗主动脉疾病的有效性和安全性。方法 2013年4月至2014年2月期间，共12例主动脉疾病患者接受Castor支架治疗，其中主动脉夹层9例，胸主动脉瘤2例，主动脉穿通性溃疡1例。结果 手术成功率为100％，无I型内漏，无围手术期死亡，无脑卒中、急性心肌梗死、上肢缺血等严重并发症，术后近期随访CTA 显示主动脉胸段假腔内血栓形成，无内漏。结论 Castor支架在主动脉疾病治疗中可以有效重建左侧锁骨下动脉血运，无严重近期并发症，远期结果仍需跟踪多病例的长期观察。
【摘要】目的 评估分支TEVAR技术治疗复杂主动脉弓部病变的近期疗效。方法 回顾性分析天津医科大学总医院2016年4月至2018年12月应用分支TEVAR技术治疗的18例需重建左锁骨下动脉的主动脉病变患者的围手术期及随访资料。结果 置入Castor外分支支架16例，自制内分支支架2例，器械释放成功率100%，手术成功率100%，无术中死亡病例。术后并发症2例：支架近端逆撕夹层1例（行开放手术）、大面积心梗1例（死亡）。 17例患者获得随访，随访时间1~8个月。 术后第30天16例CTA检查1例发生III型内漏，分支支架血流通畅。术后6个月8例CTA检査无内漏,1例左锁骨下动脉支架远端闭塞,予远端置入支架解决，无新发死亡病例。结论 分支TEVAR技术是重建弓上分支动脉的有效方法。
【摘要】目的 探讨应用Castor分支型主动脉覆膜支架治疗健康锚定区不足15mm的Stanford B型主动脉夹层(TBAD)的临床效果。方法 回顾性分析解放军第九七O医院2017年10月至2018年6 月应用Castor单分支型支架治疗18例近端健康锚定区<15 mm的TBAD患者的临床资料，其中急性TBAD17例，慢性TBAD1例，患者均经CT血管成像(CTA)确诊。结果 手术成功率100%，手术平均 时间(127.8±20.1)min，均无内漏发生，围术期无脑梗死、夹层动脉瘤破裂等并发症，无死亡病例。术中2例左锁骨下动脉(LSA)分支支架释放后存在狭窄，给予球囊扩张后狭窄解除；1例术后出现左侧肱动脉穿刺点血肿，经保守治疗治愈。随访18例，平均随访时间(8±2)个月，无截瘫及死亡病例，LSA分支支架通畅率为100%，无内漏及夹层逆撕，胸主动脉段真腔直径较术前明显扩大、假腔直径较术前明显缩小(P<0.05)，胸段假腔术后血栓化率高于腹主动脉。结论 Castor分支型覆膜支架治疗近端健康锚定区不足15mm的TBAD可以有效重建LSA，操作安全精准，隔绝效果好，短期随访无内漏发生，远期疗效尚需进一步观察。
【摘要】 目的 总结单分支型主动脉支架在Stanford B型主动脉夹层的腔内隔绝治疗经验。方法 2013年7月至2014年2月复旦大学附属中山医院血管外科对11例近端破口距离左锁骨下动脉开口<20mm的Stanford B型主动脉夹层应用一体化单分支型主动脉支架行腔内隔绝治疗，观察术后即时血管造影结果、术后1个月门诊随访、术后6个月行主动脉CT血管造影(CTA)检查。以动脉瘤相关存活率、手术成功率和分支支架通畅率为有效性终点指标，并观察相应的不良事件。结果 11例中10例术中支架释放成功，1例分支支架无法进入左锁骨下动脉而放弃。平均手术时间(130.0±36.0)min，围手术期无不良事件。随访期10例病人中无死亡，1例出现支架远端内漏，1例出现左锁骨下动脉支架闭塞，余支架封堵良好，夹层假腔均出现血栓化，假腔直径平均缩小12mm。 结论 单分支型主动脉支架对于近端破口距左锁骨下动脉开口<20 mm的Stanford B型主动脉夹层是有效的腔内隔绝方法。
Implantation of Unibody Single-Branched Stent Graft for Patients with Type B Aortic Dissections Involving the Left Subclavian Artery 1-Year Follow-Up Outcomes
【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.
Thoracic Endovascular Aortic Repair Combined with Assistant Techniques and Devices for the Treatment of Acute Complicated Stanford Type B Aortic Dissections Involving Aortic Arch
【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.
Endovascular repair by customized branched stent-graft: A promising treatment for chronic aortic dissection involving the arch branches
【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)