累及内脏区主动脉病变腔内治疗的技术进展与临床挑战

Endovascular management of aortic diseases involving the visceral segment: technical advances and clinical challenges

摘要:

累及内脏区的主动脉病变解剖结构复杂、并发症发生风险高，传统开放手术围手术期创伤大、病死率高，治疗策略面临诸多挑战。近年来，随着腔内治疗技术的快速发展，开窗支架、分支支架及平行支架等技术不断成熟，使复杂内脏区主动脉病变的微创治疗成为可能。大量研究显示，腔内治疗在降低围手术期并发症发生率、改善短期生存率及促进术后恢复方面具有明显优势，尤其适用于高龄及高危患者。然而，其在适应证选择、支架材料与结构优化、影像学精准引导、技术标准化及远期疗效评估等方面仍存在争议与不足。本文围绕累及内脏区主动脉病变的腔内治疗策略，系统综述了近年来在适应证、支架与材料进展、影像学与新技术应用以及临床疗效与预后评估等方面的研究进展，并对未来个体化治疗、多学科协作及长期随访的发展方向进行展望，以期为临床实践与后续研究提供参考。

Abstract:

Aortic pathologies involving the visceral segment are characterized by complex anatomy and a high risk of perioperative complications. Although open surgical repair remains a definitive treatment, its invasiveness and associated morbidity limit its application, particularly in elderly and high-risk patients. Advances in endovascular techniques, including fenestrated, branched, and parallel stent-graft technologies, have significantly expanded the therapeutic options for complex aortic lesions involving visceral arteries. Current evidence suggests that endovascular repair offers favorable short-term outcomes, reduced perioperative morbidity, and faster recovery compared with conventional open surgery. Nevertheless, challenges remain regarding patient selection, stent-graft design and materials, imaging-guided precision, procedural standardization, and long-term durability. This review summarizes recent progress in endovascular management of aortic diseases involving the visceral segment, focusing on indications, technological innovations, imaging applications, and clinical outcomes. Future directions, including individualized treatment strategies, multidisciplinary collaboration, and long-term outcome assessment, are also discussed to inform clinical practice and future research.