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目的评价经皮开窗术治疗主动脉夹层引起的内脏及下肢缺血。方法6例主动夹层并发内脏及下肢缺血患者行经皮开窗术,所有患者皆是Stanford B型夹层,累及的血管有肾动脉(3条)、肠系膜动脉(1条)和下肢动脉(6条)。4例行单纯经皮开窗术,1例行开窗及左肾动脉支架置入治疗,1例行开窗及腹主动脉和双侧髂总动脉支架置入治疗。1例患者于开窗后1个月行支架移植物复合体(stent-graft)腔内隔绝术。结果所有6例患者血管重建均成功,其中4例缺血症状消失,2例明显减轻。随访4~12个月,平均7.6个月,1例患者术后3个月死于主动脉破裂出血,余5例仍存活。无严重的手术相关并发症。结论经皮开窗术或经皮开窗结合支架置入是1种安全、有效的治疗主动脉夹层引起的内脏及下肢缺血的方法。
Objective To evaluate percutaneous fenestration in the treatment of aortic dissection caused by visceral and lower limb ischemia. Methods Six patients with active intercostal and visceral and lower limb ischemia underwent percutaneous fenestration. All patients were Stanford type B dissection. The involved vessels included 3 renal arteries, 1 mesenteric artery and 6 lower extremity arteries. ). 4 cases of simple percutaneous fenestration, 1 case of fenestration and left renal artery stent placement, 1 case of fenestration and abdominal aorta and bilateral common iliac artery stent placement. One patient underwent endovascular stent-graft endovascular surgery 1 month after the fenestration. Results All 6 patients were successful in revascularization, 4 of them disappeared and 2 of them were relieved. All cases were followed up for 4 to 12 months with an average of 7.6 months. One patient died of ruptured aorta at 3 months after operation, and the remaining 5 patients survived. No serious surgery-related complications. Conclusion Percutaneous fenestration or percutaneous fenestration combined with stenting is a safe and effective method for the treatment of visceral and lower limb ischemia caused by aortic dissection.