2021 年第 2 期 第 16 卷

主动脉夹层支架置入术后左锁骨下动脉Ⅱ型内漏的诊断与介入治疗

Diagnosis and interventional treatment of type Ⅱ endoleak of left subclavian artery after aortic dissection stent implantation

作者：彭明亮杨呈伟黄连军

英文作者：Peng Mingliang Yang Chengwei Huang Lianjun

单位：上海德达医院介入科201702

英文单位：Interventional Department Shanghai Delta Hospital Shanghai 201702 China

关键词：主动脉夹层；Ⅱ型内漏；诊断及介入栓塞治疗

英文关键词：Aorticdissection;TypeⅡendoleak;Diagnosisandinterventionalembolization

• 摘要：

• 目的 探讨主动脉夹层支架置入术后(介入或外科支架)左锁骨下动脉Ⅱ型内漏的诊断及介入治疗方法。方法 回顾性研究2017年11月至2020年5月在上海德达医院诊断为主动脉夹层支架置入术后内漏的全部患者，对其中确诊为左锁骨下动脉Ⅱ型内漏并行介入栓塞治疗的患者资料进行分析，总结其诊断及介入治疗方法。结果 胸腹主动脉CT血管成像（CTA）诊断主动脉夹层支架置入后内漏共14例，经术中造影证实单纯左锁骨下动脉Ⅱ型内漏8例。对单纯左锁骨下动脉Ⅱ型内漏患者全部进行介入栓塞治疗，6例完全栓塞，假腔完全血栓化，2例栓塞后仍有内漏。结论 主动脉CTA+延迟扫描是发现主动脉夹层支架置入术后内漏的敏感、有效的方法，但无法明确内漏的具体分型；升主动脉造影+支架近端假腔或左锁骨下动脉近端选择性造影能明确支架近端内漏的具体分型并为介入治疗提供指导，介入栓塞左锁骨下动脉近端是治疗主动脉夹层支架置入后左锁骨下动脉Ⅱ型内漏的安全、有效的方法。

• Objective To investigate the diagnosis and interventional treatment of left subclavian artery type Ⅱendoleak after aortic dissection stent implantation. Methods From November 2017 to May 2020, all patients diagnosed as endoleak after aortic dissection stent implantation in Shanghai Delta Hospital were retrospectively analyzed. The Data of patients with left subclavian artery type Ⅱ endoleak underwent interventional embolization were analyzed. The diagnosis and interventional treatment methods of left subclavian artery type Ⅱ endoleak after aortic dissection stent implantation were summarized. Results  There were 14 cases diagnosed as endoleak after aortic dissection stent implantation by CT angiography(CTA). There were 8 cases diagnosed as simple left subclavian artery type Ⅱ endoleak by radiography during operation. All patients with left subclavian artery type Ⅱ endoleak were treated by interventional embolization. Among them, 6 cases were completely embolized and the false lumen was completely thrombolized; 2 cases  still had endoleak after embolization. Conclusions CTA+delayed scan of aorta is a sensitive and effective method to detect endoleak after aortic dissection stent implantation, but the specific classification of endoleak cannot be determined. Ascending aorta angiography + false lumen of proximal stent or selective angiography of proximal subclavian artery can identify the specific classification of proximal endoleak and provide guidance for interventional treatment. Interventional embolization of the proximal left subclavian artery is a safe and effective method for the treatment of left subclavian artery type Ⅱ endoleak after aortic dissection stent implantation.