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

摘要：

胸主动脉腔内修复术（TEVAR）联合弓部分支激光原位开窗技术，很大程度解决了常规TEVAR可能遇到的近端锚定区不足、支架移位、“鸟嘴”构型、近端内漏及逆撕等难题，但技术操作上仍有一定的难度和风险，体外临时鞘管转流可胜任脑保护，但须熟练掌握其流程，并要求尽快完成原位开窗。对于一些“Ⅲ型弓”或“陡弓”、扭曲的左锁骨下动脉、弓部巨大动脉瘤等挑战性的弓部解剖，激光原位开窗要注意一定的策略和技巧。

关键词: 主动脉弓, 腔内修复, 激光, 原位开窗