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1、经颈部入路腔内治疗一例真性无名动脉瘤,浙江大学医学院附属第一医院 血管外科 吴子衡 何杨燕 张鸿坤 李鸣,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,L
2、iteratures,Puech-Leo 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. Eigh
3、t-year follow-up of endovascular repair 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,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 *1
4、20mm 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 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
5、treated with a tapered endograft made from polyester 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,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!,