经颈部入路腔内治疗一例真无名动脉瘤

1、经颈部入路腔内治疗一例真性无名动脉瘤,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,Literatures,Puech-Leo P, et al. Endova

2、scular 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. Eight-year follow-up of endovascular repa

3、ir 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 *120mm Talent 裤腿支架, 5mm 突入主动脉弓; MPA 导管经右肱动

4、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 treated with a tapered endograft made from po

5、lyester 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