关键词: 主动脉弓, 腔内修复, 激光, 原位开窗

Abstract:

Technical difficulties and evaluation of laser in-situ fenestration for reconstruction of the branches of aortic arch        LIU Xiao-bing，LU Xin-wu. The Vascular Center, Department of Vascular Surgery, the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Corresponding author：LU Xin-wu，E-mail：luxinwu@aliyun.com
Abstract    TEVAR combined with laser in-situ fenestration of aortic arch branches has solved many problems in conventional TEVAR，such as insufficient proximal anchorage area，stent graft migration，“birdbill”configuration，proximal endoleak or retrograde aortic dissection （RTAD）. However，there are still some difficulties and risks in technical operation. Temporary sheath bypass in vitro can be competent for brain protection，but it needs to be mature to master the procedure and complete the in situ fenestration as soon as possible. Some challenging arches such as "Type Ⅲ arch" or "steep arch"，twisted left subclavian artery and giant arch aneurysm should be accomplished with certain skills and strategies with laser in-situ fenestration.

Key words: aortic arch, endovascular repair, laser, in-situ fenestration