摘要
背景与目的:主动脉弓部疾病的腔内修复需兼顾病灶有效隔绝与弓上分支血管灌注,是当前血管外科领域的重要挑战。Castor分支型主动脉覆膜支架具备结构完整、一体化重建左锁骨下动脉(LSA)血流的优势,联合左颈总动脉(LCCA)烟囱支架技术,有望为近端锚定区不足的弓部病变提供微创、可行的治疗方案。本研究旨在评估该联合技术的初步可行性与安全性,为复杂主动脉弓病变的腔内治疗提供临床参考。方法:回顾性纳入2023年2月—2024年12月在中南大学湘雅二医院接受Castor分支型支架联合LCCA烟囱支架技术治疗的15例主动脉弓部疾病患者,分析其基线特征、手术过程、围手术期并发症及随访结果,评估技术成功率、并发症发生率及分支血管通畅率。结果:15例患者中男性11例,平均年龄63.8岁,病种包括主动脉夹层(33.4%)、弓部动脉瘤(53.3%)及穿透性主动脉溃疡(13.3%)。手术技术成功率100%,围手术期无死亡及严重并发症。随访时间4~26个月(平均12.9个月),期间无脑卒中、瘫痪、内漏、支架移位等并发症发生,LCCA与LSA通畅率均为100%。结论:Castor分支型主动脉覆膜支架联合LCCA烟囱支架技术在治疗近端锚定区不足的主动脉弓部病变中展现出良好的技术可行性与短期安全性,有望成为复杂主动脉弓腔内治疗的新选择。但仍需大样本、多中心、长期随访研究进一步验证其远期疗效与安全性。
Background and Aims:Endovascular repair of aortic arch diseases poses a major challenge in vascular surgery due to the need to both effectively exclude the lesion and preserve perfusion of supra-aortic branch vessels.The Castor branched aortic covered stent,with its integrated design and ability to maintain left subclavian artery(LSA)patency,offers potential advantages.When combined with the chimney technique for the left common carotid artery(LCCA),it may provide a minimally invasive and feasible solution for patients with insufficient proximal landing zones.This study aims to evaluate the preliminary feasibility and safety of this combined approach and provide clinical reference for the endovascular management of complex aortic arch pathologies.Methods:A retrospective analysis was conducted on 15 patients with aortic arch diseases who underwent treatment with the Castor branched stent-graft combined with LCCA chimney stenting at the Second Xiangya Hospital of Central South University between February 2023 and December 2024.Baseline characteristics,surgical procedures,perioperative complications,and follow-up outcomes were analyzed to assess technical success,complication rates,and branch vessel patency.Results:Among the 15 patients(11 males,average age 63.8 years),primary diagnoses included aortic dissection(33.4%),aortic arch aneurysm(53.3%),and penetrating aortic ulcer(13.3%).The technical success rate was 100%,with no perioperative deaths or major complications.During the follow-up period(4-26 months,mean 12.9 months),no adverse events such as stroke,paralysis,endoleak,or stent migration occurred.The patency rate of both the LCCA and LSA remained 100%.Conclusion:The Castor branched aortic stent-graft combined with LCCA chimney technique appears to be a technically feasible and safe short-term option for treating aortic arch diseases with insufficient proximal landing zones.It may serve as a promising alternative for complex aortic arch repair;however,large-scale,multicenter studies with long-term follow-up are needed to further validate its efficacy and safety.
作者
张雷
夏德芗
李睿
郭鹏程
李鑫
舒畅
ZHANG Lei;XIA Dexiang;LI Rui;GUO Pengcheng;LI Xin;SHU Chang(Department of Vascular Surgery,Second Xiangya Hospital,Central South University,Changsha 410011,China;Institute of Vascular Disease,Central South University,Changsha 410011,China;Department of Vascular Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)
出处
《中国普通外科杂志》
北大核心
2025年第6期1130-1138,共9页
China Journal of General Surgery
基金
国家自然科学基金资助项目(82120108005)
中南大学研究生自主探索创新基金资助项目(2022XQLH153)。
关键词
主动脉疾病
支架
烟囱支架技术
血管内操作
Aortic Diseases
Stents
Chimney Technique
Endovascular Procedures
