經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件

經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤1發(fā)病率IAA發(fā)病率相對(duì)少見；

約占全身動(dòng)脈瘤3%。StolfNA,etal.Surgicaltreatmentofrupturedaneurysmsoftheinnominateartery.AnnThoracSurg1983;35(4):394-9.發(fā)病率IAA發(fā)病率相對(duì)少見；StolfNA,etal2病因動(dòng)脈硬化外傷胸廓出口綜合癥梅毒大動(dòng)脈炎結(jié)締組織病Marfan綜合癥Behcet’s病病因動(dòng)脈硬化3臨床表現(xiàn)壓迫癥狀

聲音嘶啞

吞咽困難

呼吸困難繼發(fā)缺血

TIA

腦梗氣管-無名動(dòng)脈瘺

臨床表現(xiàn)壓迫癥狀4經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件5LiteraturesPuech-Le?oP,etal.Endovascularrepairofaninnominatearterytrueaneurysm.JEndovascTher.2001Aug;8(4):429-32.ParkJH,etal.Aorticandarterialaneurysmsinbehcetdisease:managementwithstent-grafts--initialexperience.Radiology.2001;220(3):745-50.AngilettaD,etal.Eight-yearfollow-upofendovascularrepairofabrachiocephalictrunkaneurysmduetoTakayasu'sarteritis.JVascSurg.2012;56(2):504-7.LiteraturesPuech-Le?oP,etal6CaseReport64歲男性;偶發(fā)頭暈1年;MRI:腦室周邊散在小缺血灶;CTA:無名動(dòng)脈瘤，范圍幾乎累及整個(gè)無名動(dòng)脈，主動(dòng)脈嚴(yán)重硬化伴斑塊，降主動(dòng)脈局部膨隆。CaseReport64歲男性;7經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件8手術(shù)經(jīng)過全麻;系統(tǒng)肝素化;股動(dòng)脈入路進(jìn)豬尾導(dǎo)管;胸鎖乳突肌前緣切口;頸總A阻斷，近端入路進(jìn)標(biāo)記導(dǎo)管。

手術(shù)經(jīng)過全麻;9經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件10Procedures16mm*120mmTalent褲腿支架,5mm突入主動(dòng)脈弓;MPA導(dǎo)管經(jīng)右肱動(dòng)脈入路栓塞瘤腔。Procedures16mm*120mmTalent褲11經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件12Proceduresandresults穿刺近端阻斷，先后松阻斷鉗排氣排碎屑;頸動(dòng)脈6-0CV；

股動(dòng)脈Proglide;無出血/血腫/上肢缺血/腦梗等。Proceduresandresults穿刺近端阻斷，先13ResultsandFollow-up脈搏消失，無感覺異常/上肢乏力;術(shù)后第3個(gè)月CTA。

ResultsandFollow-up脈搏消失，無感覺異14經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件15手術(shù)指征潛在風(fēng)險(xiǎn)，約11%破裂;直徑36mm；附壁血栓和硬化斑塊；手術(shù)指征潛在風(fēng)險(xiǎn)，約11%破裂;16技術(shù)注意點(diǎn)左椎A(chǔ)優(yōu)勢(shì)；近端錨定區(qū)短；

頸總A作為遠(yuǎn)段錨定區(qū)可防遠(yuǎn)處移位；技術(shù)注意點(diǎn)左椎A(chǔ)優(yōu)勢(shì)；17DeviceschoosePuech-Le?oreportedacasetreatedwithataperedendograftmadefrompolyestergraftattachedtoaPalmazstent,ParktreatedanIAAcausedbyBehcer’sdiseasewithaballoon-expandablestent(Jostent-graft,Jomed,Rangendingen,Germany).GoreExcluderendoprosthesis(W.L.GoreandAssociates,Flagstaff,Ariz)waspositionedtoexcludeIAAduetoTakayasu’sdisease.WefirstusedtheTalentlimbstentgraft.DeviceschoosePuech-Le?orepo18經(jīng)頸部入路優(yōu)勢(shì)支架容易到位；術(shù)中可阻斷頸總A，縫合前可排氣排碎片；

避免經(jīng)股A入路引起主動(dòng)脈弓部斑塊脫落進(jìn)入左頸動(dòng)脈，引起腦梗。經(jīng)頸部入路優(yōu)勢(shì)支架容易到位；19小結(jié)個(gè)體化腔內(nèi)治療效果滿意；長(zhǎng)期療效有待進(jìn)一步隨訪。小結(jié)個(gè)體化腔內(nèi)治療效果滿意；20Tnankyouforyourattention!Tnankyouforyourattention!21經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤22發(fā)病率IAA發(fā)病率相對(duì)少見；

約占全身動(dòng)脈瘤3%。StolfNA,etal.Surgicaltreatmentofrupturedaneurysmsoftheinnominateartery.AnnThoracSurg1983;35(4):394-9.發(fā)病率IAA發(fā)病率相對(duì)少見；StolfNA,etal23病因動(dòng)脈硬化外傷胸廓出口綜合癥梅毒大動(dòng)脈炎結(jié)締組織病Marfan綜合癥Behcet’s病病因動(dòng)脈硬化24臨床表現(xiàn)壓迫癥狀

聲音嘶啞

吞咽困難

呼吸困難繼發(fā)缺血

TIA

腦梗氣管-無名動(dòng)脈瘺

臨床表現(xiàn)壓迫癥狀25經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件26LiteraturesPuech-Le?oP,etal.Endovascularrepairofaninnominatearterytrueaneurysm.JEndovascTher.2001Aug;8(4):429-32.ParkJH,etal.Aorticandarterialaneurysmsinbehcetdisease:managementwithstent-grafts--initialexperience.Radiology.2001;220(3):745-50.AngilettaD,etal.Eight-yearfollow-upofendovascularrepairofabrachiocephalictrunkaneurysmduetoTakayasu'sarteritis.JVascSurg.2012;56(2):504-7.LiteraturesPuech-Le?oP,etal27CaseReport64歲男性;偶發(fā)頭暈1年;MRI:腦室周邊散在小缺血灶;CTA:無名動(dòng)脈瘤，范圍幾乎累及整個(gè)無名動(dòng)脈，主動(dòng)脈嚴(yán)重硬化伴斑塊，降主動(dòng)脈局部膨隆。CaseReport64歲男性;28經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件29手術(shù)經(jīng)過全麻;系統(tǒng)肝素化;股動(dòng)脈入路進(jìn)豬尾導(dǎo)管;胸鎖乳突肌前緣切口;頸總A阻斷，近端入路進(jìn)標(biāo)記導(dǎo)管。

手術(shù)經(jīng)過全麻;30經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件31Procedures16mm*120mmTalent褲腿支架,5mm突入主動(dòng)脈弓;MPA導(dǎo)管經(jīng)右肱動(dòng)脈入路栓塞瘤腔。Procedures16mm*120mmTalent褲32經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件33Proceduresandresults穿刺近端阻斷，先后松阻斷鉗排氣排碎屑;頸動(dòng)脈6-0CV；

股動(dòng)脈Proglide;無出血/血腫/上肢缺血/腦梗等。Proceduresandresults穿刺近端阻斷，先34ResultsandFollow-up脈搏消失，無感覺異常/上肢乏力;術(shù)后第3個(gè)月CTA。

ResultsandFollow-up脈搏消失，無感覺異35經(jīng)頸部入路腔內(nèi)治療一例真無名動(dòng)脈瘤課件36手術(shù)指征潛在風(fēng)險(xiǎn)，約11%破裂;直徑36mm；附壁血栓和硬化斑塊；手術(shù)指征潛在風(fēng)險(xiǎn)，約11%破裂;37技術(shù)注意點(diǎn)左椎A(chǔ)優(yōu)勢(shì)；近端錨定區(qū)短；

頸總A作為遠(yuǎn)段錨定區(qū)可防遠(yuǎn)處移位；技術(shù)注意點(diǎn)左椎A(chǔ)優(yōu)勢(shì)；38DeviceschoosePuech-Le?oreportedacasetreatedwithataperedendograftmadefrompolyestergraftattachedtoaPalmazstent,ParktreatedanIAAcausedbyBehcer’sdiseasewithaballoon-expandablestent(Jostent-graft,Jomed,Rangendingen,Germany).GoreExcluderendoprosthesis(W.L.GoreandAssociates,Flagstaff,Ariz)waspositionedtoexcludeIAAduetoTakayasu’sdisease.WefirstusedtheTalentlimbstentgraft.Devices