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目的在主动脉腔内修复术中对需要植入左侧锁骨下动脉支架的患者,应用i Flow技术即时评判在支架植入后对血流的影响,结合术后大血管CTA复查结果,综合判断左侧锁骨下动脉支架通畅率的影响因素。方法回顾性分析2013-01—2013-12北京安贞医院介入诊疗科收治的B型主动脉夹层患者214例,其中单纯行主动脉腔内修复术192例,行主动脉腔内修复术+左侧锁骨下动脉支架植入术22例,使用i Flow软件分析患者术前及术后胸主动脉造影影像,分别在主动脉近弓处(主动脉支架前)、无名动脉起始处、左侧锁骨下动脉起始处、左侧椎动脉起始处及左侧腋动脉中段水平设置感兴趣区,采集参数包括ROI Area、ROI Peak/Ref Peak、ROI Peak Time、ROI AUC/Ref AUC,进行统计学分析。结果 ROI Peak Time在主动脉腔内修复术植入和不植入左侧锁骨下动脉“烟囱”支架患者的各感兴趣区之间无明显差异。结论对锚定区较短的患者,在TEVAR术中并行左侧锁骨下动脉支架植入术是安全的,能够保证左侧锁骨下动脉、左侧椎动脉及左侧腋动脉血供;i Flow技术于术中即可以做到一站式评估TEVAR术中左侧锁骨下动脉支架的血流动力学改变,是一种辅助医生即时判断治疗效果及预测预后的有效方法,值得进一步探讨与推广。
Objective To evaluate the effect of i Flow technique on blood flow after stent implantation in patients undergoing aortic endovascular repair who need implantation of the left subclavian artery stent. Combined with the postoperative review of large vessel CTA, Influence factors of left subclavian artery stent patency rate. Methods A retrospective analysis of 214 patients with type B aortic dissection admitted to the Anzhen Hospital of Beijing between January 2013 and December 2013 was performed. Among them, 192 patients underwent endovascular aortic repair alone and underwent aortic endovascular repair plus left Side lobe supraclavicular artery stent implantation in 22 cases, using i Flow software analysis of patients before and after thoracic aortography, respectively, at the aortic arch (aortic stent), the beginning of the innominate artery, the left The region of interest was set at the beginning of the subclavian artery, at the origin of the left vertebral artery, and at the midpoint of the left axillary artery. The parameters of acquisition included ROI Area, ROI Peak / Ref Peak, ROI Peak Time, ROI AUC / Ref AUC, Analysis. Results There was no significant difference in ROI Peak Time between regions of interest in patients undergoing aortic endovascular repair and without implantation of the left subclavian artery “” chimney "stent. Conclusions In patients with short anchoring areas, parallel left subclavian artery stent implantation in TEVAR is safe and can ensure blood supply to the left subclavian artery, left vertebral artery and left axillary artery. I Flow One-stop evaluation of the hemodynamic changes of the left subclavian artery stenting in TEVAR during surgery can be an effective method to assist doctors in judging the therapeutic effect and predicting the prognosis immediately, which is worth further exploration and promotion.