腔内支架人工血管植入治疗主动脉瘤  

ENDOVASCULAR STENT-GRAFT PLACEMENT FOR THE TREATMENT OF AORTIC ANEURYSM

作　　者：周为民[1] 高涌[1] 余朝文[1] 聂中林[1] 宋涛[1] 余立权[1] 陈世远[1] 李国平[2] 

机构地区：[1]蚌埠医学院第一附属医院血管外科,蚌埠233004 [2]蚌埠医学院第一附属医院放射科

出　　处：《现代预防医学》2009年第18期3573-3578,3581,共7页Modern Preventive Medicine

摘　　要：[目的]探讨腔内支架人工血管植入术在预防主动脉夹层、主动脉瘤破裂治疗中的应用及近中期疗效。[方法]采用腔内支架人工血管植入术治疗主动脉夹层20例、腹主动脉瘤8例和胸主动脉和腹主动脉假性动脉瘤各1例。其中1例腹主动脉瘤和1例腹主动脉假性动脉瘤并主动脉下腔静脉瘘患者植入AUI支架后加行股股动脉转流及髂总动脉结扎术。[结果]本组病例腔内治疗均获得成功。8例腹主动脉瘤和2例主动脉假性动脉瘤瘤体成功隔绝。20例主动脉夹层的假腔立刻消失。1例主动脉夹层真腔狭小者先于远端真腔内植入一金属裸支架后再植入支架人工血管治愈;1例主动脉夹层支架人工血管植入后破口成功封堵,但支架远端将真假腔间内膜撕裂,支架远端骑跨于真假腔,无支架移位。1例右位主动脉弓并主动脉夹层行腔内支架人工血管植入后破口及左锁骨下动脉均被封堵,无脑缺血及左上肢缺血症状。术中发生I型内漏4例,2例腹主动脉瘤近端各加用1Cuff、2例主动脉夹层以低压球囊扩张后内漏消失。5例术后出现移植后综合征,经对症处理后缓解。随访1个月-36个月,无移植物移位及器官缺血,除1例支架远端骑跨于真假腔者随访3个月时假腔内未见血栓形成,其他病例假腔内见血栓形成,瘤腔内血栓形成满意,无内漏发生。2例主动脉夹层伴假腔血栓形成者经随访3个月1例假腔完全消失,1例假腔重现而给予腔内支架人工血管植入而治愈。本组无截瘫及死亡病例。[结论]腔内支架人工血管植入治疗主动脉瘤创伤小、安全、恢复快,能较好地预防主动脉夹层及主动脉瘤破裂,有着较好的近、中期效果。[Objective] To explore the application and short-mid term effect of endovascular stent-graft placement in the prophylaxis of rupture of aortic dissection （AD） and abdominal aortic aneurysm （AAA）. [Methods] Endovascular stentgraft placements were performed in 20 cases of AD, 8 cases of AAA and 2 cases of aortic pseudoaneurysm. 1 case of AAA and 1 case of aortic pseudoaneurysm secondary aorta-inferior vena cava fistula were underwent aortic unitary iliac-artery （AUI） stent-graft implantation and femoral-femoral artery bypass and iliac artery ligation. [Results] All the cases were successfully treat through endovascular stent-graft placement. 8 cases of AAA and 2 cases of aortic pseudoaneurysm were successfully exclude and the false lumens of 20 cases of AD were disappeared after endovascular repair. A metal nude stent was implanted in the true lumen below the tear in 1 case of AD with narrow true lumen firstly and then the sent-graft was placed through the nude stent. The tear of 1 case of AD was successfully excluded but the end of stent-graft tore the intima between the true and false lumen, and the end of stent-graft rode and straddled between the true and false lumen. The tear and left subclavian artery were covered in 1 case of right-sided arch and AD after stent-graft implantation but there was no cerebral and left upper extremity ischemia. Type I endoleak was occurred in 4 cases, 2 cases of AAA were placed a Cuff and the other were dilated by hypopiesis balloon. Postgraft syndrome was occurred in 5 cases and it was relieved after medical treatment. During the follow-up from 1 month to 36 months, there was no stent migration and organ ischemia. There was thrombi formation in the false lumen and aneurysm sac and no endoleak, except for 1 case in which the end of stent-graft rode and straddled between the true and false lumen. 2 cases of AD with false lumen thrombosis were followed-up, the false lumen was disappeared in 1 case but the other which the false lumen was reappeared was underwent stent-gr

关 键 词：主动脉夹层 腹主动脉瘤 支架人工血管 腔内治疗 

分 类 号：R543.16[医药卫生—心血管疾病]