| 摘要 |
FIELD: medicine.SUBSTANCE: invention relates to medicine, particularly to cardiovascular surgery. Arteriotomy of the common femoral artery is performed on one side and the common femoral artery is punctured on the other side. Via the puncture approach a "pigtail" type diagnostic catheter is set into the aortic arch to introduce a contrast agent. Optimum projection for visualization is selected and aortography is performed to determine proximal fenestration, dissection sizes and its propagation in the side branches. Then via the arteriotomy access a delivery system with a stent-graft is laid. Stent-graft is laid into the zone of proximal fenestration to overlap the point of the beginning of the aortic dissection and aortography is performed to determine the ratio of proximal end of the stent-graft, the point of the wall dissection beginning and the origin of the left subclavian artery and other branches. First two overlapped crowns of the stent-graft are opened. Control aortography is performed, on which the ratio of side branches, zone of aortic dissection and overlapped part of the stent-graft are estimated. Stent-graft is opened completely and aortography is performed to estimate its position and presence of leakages. Then the “pigtail” type catheter is replaced with an intravascular ultrasonic sensor and thoracoabdominal segment of the aorta is analyzed. Herewith sizes of the true and false lumens, sections of fenestrations and thromboses, places of visceral arteries origin are identified. Then metal ballon-expanded stents with overlapping the whole dissection area are laid and installed in the thoracic and the abdominal segments of the aorta to the distal from the stent-graft. Herewith ballon post-dilatation in the stents and the stent-graft is used after installation to achieve full stretch of the stents, recovery of the aortic lumen and matching delaminated walls of the aorta. Testing aortography is performed in the end, together with an ultrasound aortic investigation to estimate the final result of the stent-graft and the metal stents implantation.EFFECT: method allows avoiding the necessity of repeated operations, reducing the risk of complications, such as aortoclasia, restoring occluded side branches by intraoperative intravascular ultrasonic examination of the aorta, ballon angioplasty in zones with insufficient dissection with the stent.4 cl, 1 ex |
