Si Yi, Fu Wei-guo, Wang Yu-qi, Xu Xin, Guo Da-qiao, Chen Bin, Jiang Jun-hao, Yang Jue, Shi Zhen-yu, Zhu Ting, Shi Yun, Dong Zhi-hui
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Zhonghua Wai Ke Za Zhi. 2009 Dec 15;47(24):1868-72.
To describe observation of security and availability of covering left subclavian artery during thoracic endovascular aortic repair (TEVAR) in follow-up.
From December 2007 to December 2008, 111 consecutive patients received stent grafts to treat lesions involving thoracic aorta. According to the covering of left subclavian artery, four groups including total covering (TC), less-than 50% covering (LTC), more-than 50% covering (MTC) and non-covering (NC) were formed. Difference of blood pressure between two upper extremities was required before TEVAR and 1st, 3rd, 5th, 30th day after TEVAR. Patients were evaluated postoperatively and at follow-up for stroke as well as symptoms of paraplegia, hemiparalysis or left upper extremity claudication.
Fifty-five (49.6%), 18 (16.2%), 7 (6.3%) and 31 (27.9%) cases were divided into TC, LTC, MTC and NC groups, respectively. Difference of blood pressure between TC and the 3 latter groups were significantly different (P<0.01). Complications appeared as followed during one week after TEVAR: 13 patients in dizziness, among which 5 patients suffered from amaurosis and spotted vision, and 7 patients in left upper extremity claudication. No stroke, paraplegia or hemiparalysis in TC. Thoracic aortic lesions were successfully excluded in all patients.
Intentional coverage of left subclavian artery to obtain an adequate proximal landing zone during TEVAR is safe and well-tolerated. But it may be managed expectantly with some exceptions for further lasting efficacy.
描述在胸主动脉腔内修复术（TEVAR）随访中对左锁骨下动脉覆盖情况的安全性及有效性观察。
2007年12月至2008年12月，111例连续患者接受了支架型人工血管治疗胸主动脉病变。根据左锁骨下动脉的覆盖情况，分为完全覆盖（TC）、覆盖不足50%（LTC）、覆盖超过50%（MTC）和未覆盖（NC）四组。在TEVAR术前及术后第1、3、5、30天测量双侧上肢血压差值。术后及随访时评估患者是否发生中风以及截瘫、偏瘫或左上肢间歇性跛行症状。
分别有55例（49.6%）、18例（16.2%）、7例（6.3%）和31例（27.9%）被分为TC、LTC、MTC和NC组。TC组与后三组的血压差值有显著差异（P<0.01）。TEVAR术后一周内出现的并发症如下：13例头晕，其中5例有黑矇和视力模糊，7例左上肢间歇性跛行。TC组无中风、截瘫或偏瘫发生。所有患者的胸主动脉病变均成功排除。
在TEVAR术中为获得足够的近端锚定区而有意覆盖左锁骨下动脉是安全且耐受性良好的。但在某些情况下可进行保守处理以获得更持久的疗效。
