应用主动脉夹层隔膜穿刺破膜技术治疗覆膜支架误置入夹层假腔

潘烨.应用主动脉夹层隔膜穿刺破膜技术治疗覆膜支架误置入夹层假腔.中华创伤杂志[J].2013, 29(3):216-220

主动脉腔内修复术,

潘烨，赵珺，符伟国，梅家才，邵明哲，张健

200233,上海交通大学附属第六人民医院血管外科,复旦大学附属中山医院血管外科

2013

216-220

知网,万方

目的 探讨主动脉夹层隔膜穿刺破膜技术治疗覆膜支架误置入夹层假腔的可行性.方法 回顾性分析1例Stanford B型主动脉夹层患者,先行主动脉夹层覆膜支架腔内修复术,术后CT血管造影(CTA)发现覆膜支架位于假腔内；后行手术治疗,使用Outback LTD导管在第一支架下方2 cm处的夹层隔膜上戳孔连通真假腔,经破口置入覆膜支架使血流由假腔引回真腔,并行夹层远端破口弹簧圈栓塞. 结果 手术在局部麻醉下进行,手术时间170 min,术中出血量约350 ml.术后患者胸背部疼痛症状消失.手术后当天即开始进食、下床活动,未发生截瘫、内脏缺血等并发症.术后1周复查主动脉CTA显示支架位置理想,主动脉及主要内脏动脉血流通畅,假腔影像消失. 结论 在覆膜支架远端的夹层隔膜上开窗并置入覆膜支架与第一支架连接,将血流引回真腔,可有效治疗覆膜支架误置入假腔.采用Outback装置进行夹层隔膜的破膜操作,具有定位准确、安全系数高的特点. ： Objective To evaluate feasibility of flap fenestration in management of the condition that a stent-graft is wrongly deployed in false lumen of aortic dissection.Methods A retrospective analysis was conducted on a case of Stanford type B aortic dissection who was confirmed that the stent-graft had been wrongly deployed in false lumen of aortic dissection by CT angiography (CTA) after endovascular repair.Thereafter,an additional surgical management was carried out.At length,flap fenestration at 2 cm below pre-deployed stent-graft was performed using an Outback catheter so as to link false and true lumens.Successively,another stent-graft was placed via the access to draw blood flow from false lumen back to true lumen and then coil embolization was performed for distal breach of the dissection.Results Surgery was carried out under local anesthesia,with operation duration of 170 minutes and intraoperative blood loss of 350 ml.The chest and back pain disappeared after operation.The patient commenced to take food and take off-bed activity at the very day of operation in absence of paraplegia,visceral ischemia,or other complications.Aortic CTA at postoperative one week showed ideal positioning of stent-graft,fluent blood flow of aorta and major visceral artery,and vanishing of false lumen.Conclusions Flap fenestration at far-end of pre-deployed stent-graft so as to draw blood flow back to true lumen by connecting the new placed stent graft to pre-deployed stent-graft is an effective treatment for mis-deployment of stentgraft in false lumen of aortic dissection.Outback catheter for flap fenestration is characterized by accurate location and high safety.