“烟囱”技术在胸主动脉夹层腔内修复术中的应用分析

目的 探讨“烟囱”支架技术在近端锚定区长度不足的胸主动脉夹层的主动脉腔内修复术治疗中的应用.方法 回顾性观察2012年8月至2013年9月广东省人民医院17例近端锚定区长度不足的胸主动脉夹层患者使用“烟囱”技术进行主动脉腔内修复术治疗的临床资料.结果 男16例,女1例,Stanford B型主动脉夹层16例,Stanford B型主动脉夹层合并腹主动脉瘤1例.手术成功率为100％,支架释放后即时血管造影显示破口封堵完全,“烟囱”支架血流正常.随访3-16个月,中位时间12个月,无术后死亡患者.随访期间,患者出现左足乏力1例、头晕1例、胸闷痛2例、Ⅰ型内漏2例.无严重神经系统及脏器缺血并发症发生.术后主动脉计算机断层扫描血管造影（CTA）未见移位、明显内漏及“烟囱支架”闭塞等异常.结论 对于近端锚定区长度不足的胸主动脉夹层的患者,使用“烟囱支架技术”进行主动脉腔内修复是安全、有效的治疗方法.

Application of "chimney technology" in endovascular repair for thoracic aortic dissection

Objectives To investigate the ＂chimney technology＂ in endovascular aortic repair （EVAR） for aortic dissection with inadequate proximal anchor.Methods The study retrospectively observed 17 patients who received EVAR with ＂chimney technology＂ to treat aortic dissection with inadequate proximal anchor in Guangdong General Hospital from August 2012 to September 2013.Results The patients included 16 males and 1 female,of whom 16 were with Stanford type B aortic dissection and 1 with Stanford type B aortic dissection combined with abdominal aortic aneurysm.The technical success rate was 100％.After releasing the stent,immediate angiography result showed all the dissection tears were closed,and blood flow in ＂chimney＂ stent was normal.The patients were followed up for 12 （3-16） months.There were no postoperative deaths.There was 1 patient complained of fatigue in the left foot,1 case of dizziness,2 cases of chest pain and 2 cases of type Ⅰ endoleaks.No significant neurological complications or ischemia was detected during follow-up.Postoperative aortic computerized tomographic angiography （CTA） showed no aortic stent migration,endoleak or stent thrombosis.Conclusions For patients with inadequate proximal anchor of thoracic aortic dissection,EVAR with ＂chimney＂ technology is a safe and effective method.