CUFF 預開窗技術治療胸主動脈腔內修復術后近端內漏_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

羅明堯 ^1,3 ,  舒暢 ^1,2 , 方坤 ¹ , 張雄 ³ , 薛云飛 ¹ , 趙嘉偉 ¹ , 范博文 ¹

1. ;
2. ;
3. ;

Corresponding?author：

舒暢, Email: Changshu01@yahoo.com;changshu@vip.126.com

Keywords：

主動脈腔內修復術; Ⅰ型內漏; 開窗; 分支動脈; 主動脈

DOI：

10.7507/1007-4848.201902008

Video：

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目的探討胸主動脈腔內修復手術中即時造影提示覆膜支架近端出現Ⅰ型內漏，通過追加植入體外預開窗的支架延長段（CUFF）以延長錨定區，并消除Ⅰ型內漏的手術方式的安全性、有效性及其技術要點。方法 2016～2017 年阜外醫院血管外科中心實施胸主動脈腔內修復手術 623 例，其中 6 例患者在第 1 枚覆膜支架植入后，采取了追加植入 1 枚體外預開窗 CUFF 的方法處理了近端Ⅰ型內漏并保留了弓部分支動脈。6 例患者平均年齡 63.3（54～76）歲，男 4 例、女 2 例，其中 Stanford B 型主動脈夾層 2 例，胸主動脈假性動脈瘤 1 例，主動脈穿通性潰瘍 3 例，全部接受經股動脈途徑的胸主動脈腔內修復術治療。結果本組手術成功率 100.0%，預開窗技術分支動脈保留成功率 100.0%，預開窗平均時間 10.3（6～17）min。5 例保留了左鎖骨下動脈，1 例同時保留了左頸總動脈和左鎖骨下動脈，后者經開窗向左頸總動脈植入覆膜支架 1 枚。本組鎖骨下動脈均未植入支架。Ⅰ型內漏消除率 83.3%（5/6），1 例患者術后仍有微少量內漏，未予進一步處理。所有患者均獲得門診或電話隨訪，隨訪時間 10.3（3～25）個月，即時造影殘留微少量內漏患者于術后 3 個月隨訪時內漏完全消失，所有患者生活質量改善，無死亡患者。結論對于腔內修復治療術中出現近端Ⅰ型內漏的主動脈弓降部疾病患者，采取追加植入體外預開窗 CUFF 的方法，可在延長近端錨定區的同時成功保留弓上分支動脈。

Citation： 羅明堯, 舒暢, 方坤, 張雄, 薛云飛, 趙嘉偉, 范博文. CUFF 預開窗技術治療胸主動脈腔內修復術后近端內漏. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 106-109. doi: 10.7507/1007-4848.201902008 Copy

1.	舒暢, 羅明堯, 李全明, 等. " 煙囪”技術在累及主動脈弓部血管的動脈夾層腔內修復術中的應用. 中國普通外科雜志, 2010, 19(12): 1266-1270.
2.	袁良喜, 馮翔, 景在平. 移植物開窗腔內隔絕治療主動脈弓部動脈瘤一例. 中華外科雜志, 2007, 45(19): 1349.
3.	Clough RE, Spear R, Van Calster K, et al. Case series of aortic arch disease treated with branched stent-grafts. Br J Surg, 2018, 105(4): 358-365.
4.	舒暢, 王暾, 李全明, 等. 腔內修復聯合輔助技術治療累及主動脈弓的 Stanford B 型夾層動脈瘤. 中華普通外科雜志, 2011, 26(11): 899-903.
5.	Joseph G, Premkumar P, Thomson V, et al. Externalized guidewires to facilitate fenestrated endograft deployment in the aortic arch. J Endovasc Ther, 2016, 23(1): 160-171.
6.	Zhu J, Zhao L, Dai X, et al. Fenestrated thoracic endovascular aortic repair using physician modified stent grafts for acute type B aortic dissection with unfavourable landing zone. Eur J Vasc Endovasc Surg, 2018, 55(2): 170-176.
7.	Touma J, Verscheure D, Majewski M, et al. Parallel grafts used in combination with physician-modified fenestrated stent grafts for complex aortic aneurysms in high-risk patients with hostile anatomies. Ann Vasc Surg, 2018, 46: 265-273.
8.	Tsilimparis N, Heidemann F, Rohlffs F, et al. Outcome of surgeon-modified fenestrated/branched stent-grafts for symptomatic complex aortic pathologies or contained rupture. J Endovasc Ther, 2017, 24(6): 825-832.
9.	Canaud L, Morishita K, Gandet T, et al. Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions. J Thorac Cardiovasc Surg, 2018, 155(2): 488-493.
10.	Pearce BJ, Scali ST, Beck AW. The role of surgeon modified fenestrated stent grafts in the treatment of aneurysms involving the branched visceral aorta. J Cardiovasc Surg (Torino), 2017, 58(6): 861-869.
11.	Faure EM, Khantalin I, Peyron PA, et al. Experimental assessment of physician modified proximal scalloped stent graft to extend proximal landing zone in the aortic arch. Eur J Vasc Endovasc Surg, 2017, 54(2): 150-156.
12.	Canaud L, Baba T, Gandet T, et al. Physician-modified thoracic stent-grafts for the treatment of aortic arch lesions. J Endovasc Ther, 2017, 24(4): 542-548.
13.	Georgiadis GS, van Herwaarden JA, Antoniou GA, et al. Systematic review of off-the-shelf or physician-modified fenestrated and branched endografts. J Endovasc Ther, 2016, 23(1): 98-109.
14.	Cochennec F, Kobeiter H, Gohel M, et al. Early results of physician modified fenestrated stent grafts for the treatment of thoraco-abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2015, 50(5): 583-592.
15.	Li X, Li Q, Zhang W, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res, 2019, 23: 300060519870903.

1. 舒暢, 羅明堯, 李全明, 等. " 煙囪”技術在累及主動脈弓部血管的動脈夾層腔內修復術中的應用. 中國普通外科雜志, 2010, 19(12): 1266-1270.
2. 袁良喜, 馮翔, 景在平. 移植物開窗腔內隔絕治療主動脈弓部動脈瘤一例. 中華外科雜志, 2007, 45(19): 1349.
3. Clough RE, Spear R, Van Calster K, et al. Case series of aortic arch disease treated with branched stent-grafts. Br J Surg, 2018, 105(4): 358-365.
4. 舒暢, 王暾, 李全明, 等. 腔內修復聯合輔助技術治療累及主動脈弓的 Stanford B 型夾層動脈瘤. 中華普通外科雜志, 2011, 26(11): 899-903.
5. Joseph G, Premkumar P, Thomson V, et al. Externalized guidewires to facilitate fenestrated endograft deployment in the aortic arch. J Endovasc Ther, 2016, 23(1): 160-171.
6. Zhu J, Zhao L, Dai X, et al. Fenestrated thoracic endovascular aortic repair using physician modified stent grafts for acute type B aortic dissection with unfavourable landing zone. Eur J Vasc Endovasc Surg, 2018, 55(2): 170-176.
7. Touma J, Verscheure D, Majewski M, et al. Parallel grafts used in combination with physician-modified fenestrated stent grafts for complex aortic aneurysms in high-risk patients with hostile anatomies. Ann Vasc Surg, 2018, 46: 265-273.
8. Tsilimparis N, Heidemann F, Rohlffs F, et al. Outcome of surgeon-modified fenestrated/branched stent-grafts for symptomatic complex aortic pathologies or contained rupture. J Endovasc Ther, 2017, 24(6): 825-832.
9. Canaud L, Morishita K, Gandet T, et al. Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions. J Thorac Cardiovasc Surg, 2018, 155(2): 488-493.
10. Pearce BJ, Scali ST, Beck AW. The role of surgeon modified fenestrated stent grafts in the treatment of aneurysms involving the branched visceral aorta. J Cardiovasc Surg (Torino), 2017, 58(6): 861-869.
11. Faure EM, Khantalin I, Peyron PA, et al. Experimental assessment of physician modified proximal scalloped stent graft to extend proximal landing zone in the aortic arch. Eur J Vasc Endovasc Surg, 2017, 54(2): 150-156.
12. Canaud L, Baba T, Gandet T, et al. Physician-modified thoracic stent-grafts for the treatment of aortic arch lesions. J Endovasc Ther, 2017, 24(4): 542-548.
13. Georgiadis GS, van Herwaarden JA, Antoniou GA, et al. Systematic review of off-the-shelf or physician-modified fenestrated and branched endografts. J Endovasc Ther, 2016, 23(1): 98-109.
14. Cochennec F, Kobeiter H, Gohel M, et al. Early results of physician modified fenestrated stent grafts for the treatment of thoraco-abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2015, 50(5): 583-592.
15. Li X, Li Q, Zhang W, et al. Early experience and technical aspects of physician-modified fenestration in thoracic endovascular aortic repair for aortic arch pathologies. J Int Med Res, 2019, 23: 300060519870903.

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CUFF 預開窗技術治療胸主動脈腔內修復術后近端內漏

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