Burks James A, Faries Peter L, Gravereaux Edwin C, Hollier Larry H, Marin Michael L
Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
Ann Vasc Surg. 2002 Jan;16(1):24-8. doi: 10.1007/s10016-001-0125-5. Epub 2002 Jan 29.
The close proximity of the arch vessels to the origin of many thoracic aortic aneurysms (TAA) may result in placement of the stent struts across the left subclavian or carotid ostia. The purpose of this study is to determine the incidence and impact of transaortic arch vessel fixation during thoracic aortic stent graft deployment for the treatment of descending TAA. From May 1997 to July 2000, 20 patients (10 men, 10 women, mean age 82 years) with descending TAA were treated in the operating room with endoluminally placed stent grafts secured proximally to the thoracic aorta with a long (15-mm) uncovered stent segment (Talent LPS). Pre- and post-operative angiograms and IV contrast-enhanced spiral CT scans were performed in all cases. Follow-up contrast CT scans were obtained at 1, 3, 6, and 12 months and yearly thereafter to assess the adequacy of repair and to determine stent position and arch vessel patency. We found that thoracic aortic endograft fixation across the left aortic arch vessels occurs frequently during device placement and is associated with no early morbidity. Long-term follow-up is necessary to ensure that there are no late sequelae.
许多胸主动脉瘤（TAA）的起源部位与主动脉弓血管距离较近，这可能导致支架支柱横跨左锁骨下动脉或颈动脉开口。本研究的目的是确定在胸主动脉支架移植物置入治疗降主动脉TAA过程中，经主动脉弓血管固定的发生率及影响。1997年5月至2000年7月，20例（男10例，女10例，平均年龄82岁）降主动脉TAA患者在手术室接受治疗，通过在胸主动脉近端使用长（15毫米）无覆膜支架段（Talent LPS）将腔内放置的支架移植物固定。所有病例均进行了术前和术后血管造影以及静脉注射对比剂增强螺旋CT扫描。在术后1、3、6和12个月以及此后每年进行随访对比CT扫描，以评估修复的充分性，并确定支架位置和主动脉弓血管通畅情况。我们发现，在器械置入过程中，经主动脉弓血管固定胸主动脉内移植物的情况经常发生，且与早期发病率无关。需要长期随访以确保无晚期后遗症。
