高志伟上海长征医院血管外科.pptVIP

高志伟 上海长征医院血管外科 TEVAR术快速发展 自1994年Dake最初报道TEVAR以来，TEVAR已快速成为治疗主动脉疾病的有效方法。 Dake MD, Miller DC, Semba CP, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms.NEngl J Med 1994;331:1729-34. Gopaldas RR, Dao TK, LeMaire SA, ea al. (2011) Endovascular versus open repair of ruptured descending thoracic aortic aneurysms: a nationwide risk-adjusted study of 923 patients. J Thorac Cardiovasc Surg 142(5):1010–1018 4. Goodney PP, Travis L, Lucas FL, et al (2011) Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation 124(24):2661–2669 足够的锚定区是TEVAR术的基本要求 就技术上而言，成功的TEVAR手术要求足够长度的正常主动脉锚定区。多数报道表明，高达50%的TEVAR术中需要覆盖左锁骨下动脉（LSA），以获得足够的近端锚定区。 Feezor RJ, LeeWA (2009) Management of the left subclavian artery during TEVAR. Semin Vasc Surg 22(3):159–164 Kotelis D, Geisbüsch P, Hinz U, et al (2009) Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg 50(6):1285–1292 Lombardi JV, Cambria RP, Nienaber CA et al (2012) Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design. J Vasc Surg 55(3):629–640, e2 Steuer J, Eriksson MO, Nyman R, et al. (2011) Early and long-term outcome after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection. Eur J Vasc Endovasc Surg 41(3):318–323 既往的研究认为近端锚定区至少需要2cm，随着器具的进展，锚定区的长度虽然有所缩短，但为防止术中即刻发生的I型内漏及远期支架移位等灾难性并发症的发生，足够的锚定区对于TEVAR而言仍然意义重大。 Caronno R, Piffaretti G, Tozzi M, ea al. Intentional coverage of the left subclavian artery during endovascular stent graft repair for thoracic aortic disease. Surg Endosc 2006;20:915—8. Peterson BG, Eskandari MK, Gleason TG, et al. Utility of left subclavian artery revascularisation in association with endoluminal repair of acute and chronic thoracic aortic patholo