高危复杂腹主动脉瘤腔内修复术临床分析  

Investigation of endovascular aneurysm repair of complex abdominal aortic aneurysm in high-risk patients

作　　者：刘暴[1] 刘昌伟[1] 郑月宏[1] 李拥军[1] 吴继东[1] 吴巍巍[1] 叶炜[1] 宋小军[1] 曾嵘[1] 陈跃鑫[1] 邵江[1] 陈宇[1] 倪冷[1] 

机构地区：[1]北京协和医院血管外科,100730

出　　处：《中华外科杂志》2011年第10期878-882,共5页Chinese Journal of Surgery

基　　金：首都医学发展科研基金资助项目（2007-1027）

摘　　要：目的评估应用多种腔内技术治疗高危复杂腹主动脉瘤的可行性。方法2001年1月至2010年12月，共138例腹主动脉瘤患者接受腹主动脉腔内修复术（EVAR），其中9例患者为高危复杂性腹主动脉瘤。男性8例，女性1例，年龄26—87岁，平均67岁。其中2例近肾腹主动脉假性动脉瘤，5例近肾腹主动脉瘤，1例腹主动脉瘤合并双髂总动脉瘤及左侧髂内动脉瘤，1例EVAR术后右髂内动脉瘤。所采用的腔内技术包括：主动脉支架开窗技术和扇形技术2例，烟囱技术5例，球囊辅助下髂内动脉瘤腔内治疗1例和球囊辅助反转支架技术1例。结果所有腔内技术均获得成功。术中支架释放后即刻发现内漏4例，其中1例患者为Ⅰ型和Ⅲ型内漏，经大动脉球囊扩张后内漏消失；2例Ⅰ型内漏，其中1例行弹簧栓栓塞成功，另1例行近端裸支架成功。1例Ⅱ型内漏，经随访瘤腔直径未增大，未处理。随访4～79个月，平均25．9个月。无动脉瘤破裂，动脉瘤瘤体直径均有不同程度的缩小。随访过程中7例患者的靶血管（肾动脉、肠系膜上动脉和髂内动脉）均保持通畅。1例髂内动脉重建支架术后18个月血栓形成，但无盆腔缺血等症状。结论对于不能耐受手术的高危复杂腹主动脉瘤患者，选择合适的腔内技术可以增加EVAR术的成功率，近、中期效果满意。Objective To evaluate the results of a variety of alternative endovascular techniques applied to patients with complicated abdominal aortic aneurysm complex abdominal aortic aneurysm （cAAA） and unsuitable for open surgery. Methods From January 2001 to December 2010, charts of all patients having an abdominal aortic aneurysm （AAA） were reviewed. Endovascular aneurysm repair （EVAR） was done in 138 patients, in which 9 patients were defined as cAAA such as juxta-renal AAA, short or angulated AAA neck, AAA with bilateral iliac artery aneurysms. There were 8 male and 1 female patients, aged from 26 to 87 years with a mean of 67 years. All these patients at high risk for open surgery were offered a modified EVAR technique including fenestrated technique, scallop technique, chimney technique, balloon assisted U-turn stenting and reverse-U stent-graft in 2, 5, 1 and 1 patients respectively. Results All techniques were successful and without severe postoperative complications. An intraoperative endoleak was found in 4 patients and was corrected immediately. One patient with type I and m endoleaks underwent dilatation with a compliant balloon. Two patients with type I endoleak underwent coil embolization （ 1 patient） and bare stent （1 patient）. During follow-up, one patient with a type II endoleak who demonstrated no increase in sac diameter during follow-up was observed. Mean follow-up was 25.9 months （ranging from 4 to 79 months）. No rupture occurred and 8 aneurysms shrink significantly. In 7 patients, critical vessels （renal and mesenteric arteries） were protected during the initial procedure and remained patent except in one patient who was performed reverse ＂U＂ stent graft with thrombosis in hypogastric artery. Conclusion High-risk patients with cAAA inappropriate for traditional EVAR can be successfully treated by using simple ancillary endovascular techniques with acceptable short or mid-term results.

关 键 词：主动脉瘤 腹 血管假体植入 支架 

分 类 号：R654.3[医药卫生—外科学]