腹主动脉瘤腔内修复术中重要血管保留方法与策略  

Strategies of aortic branches preservation during theendovascular repair of abdominal aortic aneurysm

作　　者：郭宝磊 符伟国 GUO Bao-lei;FU Wei-guo(Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院血管外科,复旦大学血管外科研究所,上海200032

出　　处：《中国实用外科杂志》2018年第12期1385-1390,共6页Chinese Journal of Practical Surgery

摘　　要：腹主动脉瘤(AAA)腔内修复术(EVAR)目前已成为AAA的首选术式,但EVAR需要在动脉瘤近远端有足够的锚定区。保留或重建腹主动脉的重要血管是EVAR的前提和关键。近年来,开窗支架、分支支架的应用及烟囱技术、三明治技术、杂交技术的开展进一步拓展了AAA行EVAR的指征,肾上型AAA、主髂动脉瘤及不能耐受开放手术的高危病人等逐步得到EVAR的机会。不同技术具有各自的特点和适用范围,术者应遵循重要血管的保留原则,根据病变特点、临床经验和不同技术的适应证等因素选择合适的分支重建策略,改善EVAR的中远期预后。Endovascular aortic repair (EVAR)has gradually become the mainstream treatment of abdominal aortic aneurysm (AAA).However,EVAR requires sufficient landing zone both in the proximal and distal region of aortic aneurysm. The premise and the key for EVAR is to preserve the main branches of the abdominal aorta.Recently,with the advancement of fenestrated and branched endograft and the adoption of chimney technique,sandwich technique and hybrid technique,the indication of EVAR for AAA is expanding.Patients who present with suprarenal AAA, complex aorto-iliac aneurysm,or have the contraindication for open surgery repair,gradually got the chance to the endovascular technologies and benefit from them.Each technology has its own characteristics and scope.According to the guideline of preservation of the main branches in EVAR, surgeons should make their decision based on the specific characteristics of lesions,their experience,indication and limitations of different technologies,with the purpose of improving the long term prognosis.

关 键 词：腹主动脉瘤 腔内修复 支架 植入物 

分 类 号：R6[医药卫生—外科学]