Chen Feng, Guo Wei, Song Yuxiang, Sun Guoyi, Xiong Jiang, Jia Xin, Liu Xiaoping, Ma Xiaohui, Zhang Hongpeng
Department of Vascular and Endovascular Surgery, General Hospital of Chinese PLA, Beijing, 100853, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 May 8;30(5):599-603. doi: 10.7507/1002-1892.20160121.
To explore the effectiveness of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) with hostile stent-graft proximal landing zone.
A retrospective analysis was made on the clinical data of 13 patients with BTAI with hostile stent-graft proximal landing zone treated by TEVAR between December 2007 and December 2014. There were 10 males and 3 females with the mean age of 44 years (range, 24-64 years). The imaging examination indicated Stanford type B aortic dissection in 7 cases, pseudoaneurysm in 3 cases, aneurysm in 1 case, and penetrating ulcer in 2 cases. According to the partition method of thoracic aortic lesion by Mitchell, 8 cases underwent stent-graft with left subclavian artery (LSA) coverage, 3 underwent chimney stents for LSA, and 2 for left common carotid artery (LCCA). In 2 cases receiving chimney TEVAR involving LCCA, one underwent steel coils at the proximal segment of LSA to avoid type II endoleak and the other underwent in situ fenestration for endovascular reconstruction of LSA.
All TEVAR procedures were successfully performed. The mean operation time was 1.8 hours (range, 1-3 hours); the mean intraoperative blood loss was 120 mL (range, 30-200 mL); and the mean hospitalization time was 15 days (range, 7-37 days). No perioperative death and paraplegia occurred. The patients were followed up 3-30 months (mean, 18 months). Type I endoleak occurred in 1 case during operation and spontaneously healed within 6 months. Hematoma at brachial puncture site with median nerve compression symptoms occurred in 1 case at 3 weeks after operation; ultrasound examination showed brachial artery pseudoaneurysm and thrombosis, and satisfactory recovery was obtained after pseudoaneurysmectomy. No obvious chest pain, shortness of breath, left upper limbs weakness, numbness, and dizziness symptoms were observed. Imaging examination revealed that stentgraft and branched stent remained in stable condition. Meanwhile the blood flow was unobstructed. No lesions expanded and ruptured. No new death, bacterial infection, or other serious complications occurred.
According to Mitchell method, individualized plan may be the key to a promising result. More patients and further follow-up need to be included, studied, and observed.
探讨胸主动脉腔内修复术（TEVAR）治疗近端锚定区条件不佳的钝性胸主动脉损伤（BTAI）的有效性。
回顾性分析2007年12月至2014年12月期间接受TEVAR治疗的13例近端锚定区条件不佳的BTAI患者的临床资料。其中男性10例，女性3例，平均年龄44岁（范围24 - 64岁）。影像学检查显示，7例为Stanford B型主动脉夹层，3例为假性动脉瘤，1例为真性动脉瘤，2例为穿透性溃疡。根据Mitchell对胸主动脉病变的分区方法，8例行覆膜支架覆盖左锁骨下动脉（LSA），3例行LSA烟囱支架置入术，2例行左颈总动脉（LCCA）烟囱支架置入术。在2例行涉及LCCA的烟囱TEVAR患者中，1例在LSA近端段置入弹簧圈以避免Ⅱ型内漏，另1例对LSA进行原位开窗以行血管腔内重建。
所有TEVAR手术均成功完成。平均手术时间为1.8小时（范围1 - 3小时）；平均术中出血量为120 mL（范围30 - 200 mL）；平均住院时间为15天（范围7 - 37天）。围手术期无死亡及截瘫发生。患者随访3 - 30个月（平均18个月）。1例术中发生Ⅰ型内漏，6个月内自发愈合。1例术后3周出现肱动脉穿刺部位血肿并伴有正中神经受压症状；超声检查显示肱动脉假性动脉瘤及血栓形成，行假性动脉瘤切除术后恢复良好。未观察到明显胸痛、气短、左上肢无力、麻木及头晕症状。影像学检查显示覆膜支架及分支支架位置稳定，血流通畅，病变无扩大及破裂。无新的死亡、细菌感染或其他严重并发症发生。
根据Mitchell方法，个体化方案可能是取得良好疗效的关键。需要纳入更多患者并进行进一步随访研究和观察。
