近端瘤颈解剖结构不良的腹主动脉瘤腔内修复术  被引量:4

Endovascular repair of abdominal aortic aneurysm with hostile proximal neck anatomy

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作  者:濮欣[1] 宁一[1] 黄小勇[1] 黄杰[1] 张庆永[1] 黄连军[1] 

机构地区:[1]首都医科大学附属北京安贞医院介入诊疗科,100029

出  处:《中华放射学杂志》2017年第1期42-46,共5页Chinese Journal of Radiology

摘  要:目的:分析腔内修复术治疗近端瘤颈解剖结构不良的腹主动脉瘤的安全性及有效性。方法搜集经主动脉腔内修复的近端瘤颈解剖结构不良腹主动脉瘤患者的临床、影像资料及随访结果进行回顾性分析。本组患者男135例,女12例;年龄43.0~85.0岁,平均(68.7±8.9岁);腹主动脉瘤最大径45~100 mm,瘤颈长度7~32 mm、直径15~30 mm、成角10°~90°、瘤颈部动脉硬化改变43例。术后3、6、12个月及以后每年随访1次。随访内容为患者临床情况,主动脉CT血管成像结果(覆膜支架形态、位置,动脉瘤形态变化及瘤腔血栓化情况、内漏情况等)。结果147例患者手术均成功。120例采用常规腹主动脉覆膜支架植入术,术后即刻Ⅰa型内漏32例,其中25例于近端球囊扩张后内漏消失,7例近端加用覆膜支架延长支(Cuff)后内漏消失。3例采用开窗技术定制支架,24例加用肾动脉烟囱技术。随访6~42个月,中位时间18个月,累计生存率98.0%(144/147),随访期间支架通.率99.3%(146/147),瘤腔血栓化率97.3%(143/147)。随访期间3例死亡,2例瘤体破裂、1例原因不明;1例单侧髂支内血栓形成致管腔闭塞,1例持续Ⅲ型内漏,均行二次介入手术成功。未见支架移位、下肢缺血、感染等严重并发症。结论腔内修复术治疗近端瘤颈解剖结构不良的腹主动脉瘤安全、有效。根据动脉瘤具体情况选择支架、多种腔内修复技术联合应用及密切的随访是关键。Objective To analyze the safety and efficacy of endovascular aortic repair (EVAR) for abdominal aortic aneurysm(AAA) with hostile aortic proximal landing anatomy. Methods The clinical and imaging data of 147 AAA patients [135 males, (68.7 ± 8.9) years old, range 43-85 years old] with hostile aortic proximal landing anatomy treated by EVAR from January 2012 to December 2014 in our center were retrospectively analyzed. The range of maximum aneurysm diameter was 45-100 mm; the length range of proximal aneurysm neck was 7-32 mm;the width range of proximal aneurysm neck was 15-30 mm, and the infrarenal angulation was 10°-90° . In addition, there were atherosclerotic changes in the proximal neck in 43 cases. Follow-up protocol consisted of evaluation of clinical symptoms and cTA at 3, 6 and 12 months and annually thereafter. Results The technical success rate was 100%. Different procedures were adopted among patients, with 113 cases of EVAR, 3 cases of fenestrated EVAR and 24 cases of chimney EVAR. The intra-operative type Ia endoleak was observed in 32 cases, in which 25 of them were successfully treated by balloon angioplasty and the other 9 patients were treated with Cuff extension. During the mean follow-up period of 18 months (6-42 months), the accumulative survival rate was 98.0%(144/147),the patency rate of stents was 99.3%(146/147), and the thrombosis rate of aneurysm was 97.3%(143/147). Two patients died because of aneurysm rupture, and another case died of unknown reason. Two patients underwent secondary intervention successfully for the treatment of thrombosis formation and lumen occlusion in unilateral iliac stent in 1 case, and type Ⅲ endoleak in another case. No other complications such as misplace of stent grafts, no bilateral limb ischemia and stent infection were observed during follow-up. Conclusions EVAR is a safe and effective option to treat AAA with hostile aortic proximal landing anatomy. Choosing the most suitable stent-graft, the combination of various intervent

关 键 词:主动脉瘤  血管成形术 

分 类 号:R654.3[医药卫生—外科学]

 

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