腹主动脉瘤腔内隔绝术中短支对接困难的处理  

Difficulties in joining the short leg in endovascular graft exclusion of abdominal aortic aneurysm

作　　者：陆清声[1] 景在平[1] 赵志青[1] 包俊敏[1] 冯翔[1] 赵君[1] 

机构地区：[1]第二军医大学附属长海医院血管外科全军血管外科研究所,上海200433

出　　处：《外科理论与实践》2005年第5期437-440,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨腔内隔绝术治疗腹主动脉瘤术中短支对接困难的处理方法。方法:对本中心自1997年3月至2004年6月间施行的腹主动脉瘤腔内隔绝术进行回顾性研究。共有51例出现短支对接困难。其中,出现导丝进入主体短支产生困难的50例次,对侧单支导入主体短支产生困难的12例次。术中采用了多角度透视法、对侧导丝导引法、左肱动脉穿刺近端漂流法、导丝上下贯通法、球囊扩张法、超硬导丝回撤法和导丝牵张法。结果:多角度透视法应用于50例病人,对侧导丝导引法14例,左肱动脉穿刺近端漂流法10例,导丝上下贯通法3例,球囊扩张法2例,超硬导丝回撤法10例,导丝牵张法5例。51例病人均获成功对接,使分叉型移植物成功地隔绝了腹主动脉瘤。结论:短支对接是放置分叉型移植物手术操作过程中的难点,短支对接困难会造成手术的时间延长甚至失败。利用多种血管腔内技术可以解决这一问题。Objective To review the methods of resolving the difficulties met in joining the short leg while treating abdominal aortic aneurysms bv the method of endovaseular graft exelusion. Methods Fifty one cases of abdominal aortic aneurysms were treated with the method of endovascular graft exclusion from March 1997 to June 2004. All these 51 cases had difficuhies in joining the short leg during the operation. In 50 cases, the wires had difficulty in entering the lumen of the short leg. In 12 cases, the iliac leg graft had difficulty to join the short leg of the main graft. Seven methods to solve tilese problems were used, including： ①projection in different directions. ② guidance by wire of the opposite side, ③ proximal guide-wire floating technique by tapping the left subclavia artery. ④ transfixion of the proximal and distal guidewires. ⑤ technique of balloon dilatation, ⑥ moving retrogradely the hard wire and ⑦ technique of stretching guide-wire. Results The 1st technique was used in 50 cases, opposite the 2nd in 14 cases, the 3rd in 10 cases, the 4th in 3 cases. the 5th in 2 cases, the 6th in 10 cases, and the 7th in 5 cases. The iliac legs of the main graft ultimately joined to their distal counterparts, and the bifurcate stent-graft excluded successfully the abdominal aortic aneurysm in all 51 cases. Conclusions Joining the short leg is a key point in the method of endovascular graft exclusion of abdominal aortic aneurysm with the bifurcate stent-graft. Failure in doing so could lead to delaying, even losing the operation. This problem could be solved by a number of endovascular teehniques.

关 键 词：主动脉瘤 腹 腔内隔绝术 分叉型移植物 

分 类 号：R543[医药卫生—心血管疾病]