CUFF 预开窗技术治疗胸主动脉腔内修复术后近端内漏_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

罗明尧 ^1,3 ,  舒畅 ^1,2 , 方坤 ¹ , 张雄 ³ , 薛云飞 ¹ , 赵嘉伟 ¹ , 范博文 ¹

1. ;
2. ;
3. ;

Corresponding author：

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

Keywords：

主动脉腔内修复术; Ⅰ型内漏; 开窗; 分支动脉; 主动脉

DOI：

10.7507/1007-4848.201902008

Video：

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目的探讨胸主动脉腔内修复手术中即时造影提示覆膜支架近端出现Ⅰ型内漏，通过追加植入体外预开窗的支架延长段（CUFF）以延长锚定区，并消除Ⅰ型内漏的手术方式的安全性、有效性及其技术要点。方法 2016～2017 年阜外医院血管外科中心实施胸主动脉腔内修复手术 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 枚体外预开窗 CUFF 的方法处理了近端Ⅰ型内漏并保留了弓部分支动脉。6 例患者平均年龄 63.3（54～76）岁，男 4 例、女 2 例，其中 Stanford B 型主动脉夹层 2 例，胸主动脉假性动脉瘤 1 例，主动脉穿通性溃疡 3 例，全部接受经股动脉途径的胸主动脉腔内修复术治疗。结果本组手术成功率 100.0%，预开窗技术分支动脉保留成功率 100.0%，预开窗平均时间 10.3（6～17）min。5 例保留了左锁骨下动脉，1 例同时保留了左颈总动脉和左锁骨下动脉，后者经开窗向左颈总动脉植入覆膜支架 1 枚。本组锁骨下动脉均未植入支架。Ⅰ型内漏消除率 83.3%（5/6），1 例患者术后仍有微少量内漏，未予进一步处理。所有患者均获得门诊或电话随访，随访时间 10.3（3～25）个月，即时造影残留微少量内漏患者于术后 3 个月随访时内漏完全消失，所有患者生活质量改善，无死亡患者。结论对于腔内修复治疗术中出现近端Ⅰ型内漏的主动脉弓降部疾病患者，采取追加植入体外预开窗 CUFF 的方法，可在延长近端锚定区的同时成功保留弓上分支动脉。

Citation： 罗明尧, 舒畅, 方坤, 张雄, 薛云飞, 赵嘉伟, 范博文. CUFF 预开窗技术治疗胸主动脉腔内修复术后近端内漏. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 106-109. doi: 10.7507/1007-4848.201902008 Copy

1.	舒畅, 罗明尧, 李全明, 等. " 烟囱”技术在累及主动脉弓部血管的动脉夹层腔内修复术中的应用. 中国普通外科杂志, 2010, 19(12): 1266-1270.
2.	袁良喜, 冯翔, 景在平. 移植物开窗腔内隔绝治疗主动脉弓部动脉瘤一例. 中华外科杂志, 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.	舒畅, 王暾, 李全明, 等. 腔内修复联合辅助技术治疗累及主动脉弓的 Stanford B 型夹层动脉瘤. 中华普通外科杂志, 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. 舒畅, 罗明尧, 李全明, 等. " 烟囱”技术在累及主动脉弓部血管的动脉夹层腔内修复术中的应用. 中国普通外科杂志, 2010, 19(12): 1266-1270.
2. 袁良喜, 冯翔, 景在平. 移植物开窗腔内隔绝治疗主动脉弓部动脉瘤一例. 中华外科杂志, 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. 舒畅, 王暾, 李全明, 等. 腔内修复联合辅助技术治疗累及主动脉弓的 Stanford B 型夹层动脉瘤. 中华普通外科杂志, 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 预开窗技术治疗胸主动脉腔内修复术后近端内漏

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