经颈部入路腔内治疗一例真无名动脉瘤课件.ppt

1、经颈部入路腔内治疗一例真无名动脉瘤发病率发病率 IAA发病率相对少见；约占全身动脉瘤 3%。Stolf NA,et al.Surgical treatment of ruptured aneurysms of the innominate artery.Ann Thorac Surg 1983;35(4):394-9.病因病因 动脉硬化 外伤 胸廓出口综合症 梅毒 大动脉炎 结缔组织病 Marfan 综合症 Behcets 病临床表现临床表现 压迫症状压迫症状 声音嘶哑 吞咽困难 呼吸困难 继发缺血继发缺血 TIA 脑梗 气管气管-无名动脉瘘无名动脉瘘 Literatures Puech-Le

2、o P,et al.Endovascular repair of an innominate artery true aneurysm.J Endovasc Ther.2001 Aug;8(4):429-32.Park JH,et al.Aortic and arterial aneurysms in behcet disease:management with stent-grafts-initial experience.Radiology.2001;220(3):745-50.Angiletta D,et al.Eight-year follow-up of endovascular r

3、epair of a brachiocephalic trunk aneurysm due to Takayasus arteritis.J Vasc Surg.2012;56(2):504-7.Case Report 64岁男性;偶发头晕1年;MRI:脑室周边散在小缺血灶;CTA:无名动脉瘤，范围几乎累及整个无名动脉，主动脉严重硬化伴斑块，降主动脉局部膨隆。手术经过手术经过 全麻;系统肝素化;股动脉入路进猪尾导管;胸锁乳突肌前缘切口;颈总A阻断，近端入路进标记导管。Procedures 16mm*120mm Talent 裤腿支架,5mm 突入主动脉弓;MPA 导管经右肱动脉入路栓塞瘤腔。P

4、rocedures and results 穿刺近端阻断，先后松阻断钳排气排碎屑;颈动脉6-0 CV；股动脉Proglide;无出血/血肿/上肢缺血/脑梗等。Results and Follow-up 脉搏消失，无感觉异常/上肢乏力;术后第3个月CTA。手术指征手术指征 潜在风险，约11%破裂;直径36mm；附壁血栓和硬化斑块；技术注意点技术注意点l左椎A优势；l近端锚定区短；l颈总A作为远段锚定区可防远处移位；Devices choose Puech-Leo reported a case treated with a tapered endograft made from polyeste

5、r graft attached to a Palmaz stent,Park treated an IAA caused by Behcers disease with a balloon-expandable stent(Jostent-graft,Jomed,Rangendingen,Germany).Gore Excluder endoprosthesis(W.L.Gore and Associates,Flagstaff,Ariz)was positioned to exclude IAA due to Takayasus disease.We first used the Talent limb stent graft.经颈部入路优势经颈部入路优势 支架容易到位；术中可阻断颈总A，缝合前可排气排碎片；避免经股A入路引起主动脉弓部斑块脱落进入左颈动脉，引起脑梗。小结小结 个体化腔内治疗效果满意；长期疗效有待进一步随访。Tnank you for your attention!