合并髂动脉病变的腹主动脉瘤腔内处理方案探讨  

Endovascular treatment of abdominal aortic aneurysm complicated with iliac artery disease

作　　者：田轩[1] 刘建龙[1] 贾伟[1] 蒋鹏[1] 程志远[1] 张蕴鑫 田晨阳[1] 

机构地区：[1]北京积水潭医院血管外科,北京100035

出　　处：《中华老年多器官疾病杂志》2017年第10期729-733,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的探讨合并髂动脉病变的腹主动脉瘤(AAA)的腔内处理方案。方法回顾性分析2008年1月至2016年12月北京积水潭医院血管外科收治的AAA行腔内治疗的52例患者临床资料,包括性别、年龄、患者临床特点(冠心病、高血压、糖尿病、高脂血症)、股深动脉及股浅动脉通畅率,按照是否存在严重髂动脉病变将患者分为髂动脉通畅组和髂动脉狭窄或闭塞组,分别进行腔内治疗,并于术后接受抗凝、抗血小板治疗以防动脉粥样硬化。根据数据类型,组间比较采用t检验或x^2检验(Fisher确切概率法)。结果 52例患者被分为髂动脉通畅组41例和髂动脉狭窄或闭塞组11例,其中通畅组髂动脉严重扭曲2例(3.8%,2/52),狭窄或闭塞组髂动脉狭窄9例(17.3%,9/52)及闭塞2例(3.8%,2/52),术前两组患者性别、年龄、患者临床特点(冠心病、高血压、糖尿病、高脂血症)、股深动脉及股浅动脉通畅率比较,差异均无统计学意义(P>0.05)。两组患者均成功实施了AAA腔内修复(EVAR)术,其中通常组扭曲者通过特硬导丝纠正髂动脉成角后支架顺利通过,狭窄或闭塞组给予患侧或对侧球囊扩张或逆行开通股动脉进行扩张,支架最终顺利通过。随访了12~24个月,狭窄或闭塞组出现一侧髂动脉腿支的闭塞2例(P<0.05),1例行右髂序贯放置髂腿支架1枚+双侧股动脉人工血管转流术,术后双下肢动脉供血良好。结论合并髂动脉病变会导致AAA腔内治疗困难,运用合理的手术技巧和器材的配合,AAA患者行EVAR术均可以获得成功,远期通畅率较好。Objective To investigate the endovascular treatment for abdominal aortic aneurysm （AAA） complicated with iliac artery disease. Methods A total of 52 AAA patients who received endovascular treatment in our department from January 2008 to December 2016 were enrolled in this study. Their clinical data, such as sex, age, clinical characteristics （including coronary heart disease,hypertension, diabetes, hyperlipidemia）, and patency of deep and superficial femoral artery were collected and analyzed retrospectively. According to the severity of iliac artery disease,they were divided into patent iliac artery group and stenosis or occlu-sion iliac artery group. All patients received endovascular treatment and futher anticoagulation or antiplatelet after operation to prevent atherosclerosis. According to the data types,Student＇s t test or Chi-square test（Fisher exact probability method） was used to compare the differences between groups. Results Fifty-two were divided into patent iliac artery group （41 patients, including 2 patients with severe distortion,3.8%,2/52）and stenosis or occlusion iliac artery group（11 patients,9 patients with iliac artery stenosis,17.3%, 9/52,and 2 patients with iliac artery occlusion,3.8%,2/52）,there were no significant differences in sex,age, clinical characteris-tics,and patency of deep and superficial femoral artery between the 2 groups of patients（P〉0.05）. Two groups underwent endovas-cular exclusion successfully. Among patent group, distortion were corrected by super-hard guide wire, and in stenosis or occlusion group,balloon dilation and retrograde expansion of the femoral artery was carried out in affected limb or contralateral side. Stent were placed successfully for two groups. All patients were followed up for 12 to 24 months. Two patients had occlusion of lateral iliac artery in stenosis or occlusion group （P〈0.05）, among which one was treated with 1 leg brace in the right iliac artery and sequentially artificial vessel bypass in bilateral femoral ar

关 键 词：主动脉瘤 腹 髂动脉闭塞 髂动脉狭窄 腔内治疗 

分 类 号：R543.1[医药卫生—心血管疾病] R732.21[医药卫生—内科学]