最新：经颈部入路腔内治疗一例真无名动脉瘤文档资料.ppt

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1、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,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,压迫症状 声音嘶哑 吞咽困难 呼吸困难继发缺血 TIA 脑梗气管-无名动脉瘘,Literatures,Puech-Leo P,et al.Endovascular repair of an innominate

2、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 repair of a brachiocephalic trunk aneurysm due t

3、o 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,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。,Procedures and results,穿刺近端阻断，先后松阻断钳排气排碎屑;颈动脉6-0

4、 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,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,左椎A优势；近端锚定区短；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 polyester graft attached to a Palmaz stent,Park treated an IAA

5、 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,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,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!,