腹主动脉瘤腔内修复术血管入路并发症的处理  

Management of complications related to vascular access in endovascular abdominal aortic aneurysm repair: a retrospective analysis of 57 cases

作　　者：李追[1] 任为[1] 黄文[1] 赵渝[1] 成军[1] LI Zhui;REN Wei;HUANG Wen;ZHAO Yu;CHENG Jun(Department of Vascular Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院血管外科,重庆400016

出　　处：《第三军医大学学报》2018年第15期1407-1412,共6页Journal of Third Military Medical University

摘　　要：目的回顾性分析腹主动脉瘤腔内修复术(endovascular aneurysm repair,EVAR)中血管入路相关早期并发症的原因及处理措施。方法分析我院2015年5月至2017年5月57例EVAR患者的血管入路及其并发症的处理,并发症包括髂动脉破裂、股动脉内膜损伤、血管内支架闭塞、下肢动脉血栓形成等,对不同并发症采取覆膜支架置入、人工血管移植、股-股搭桥、Fogarty导管取栓等处理措施,并于术后30 d采用超声多普勒随访术后情况。结果 57例均完成EVAR手术,无中转开腹,其中伴有髂动脉扭曲>90°7例,股动脉直径纤细(<7 mm)3例,一侧髂动脉闭塞4例,合并髂动脉瘤5例(双侧髂动脉瘤2例,单侧髂动脉瘤3例)。入路血管并发症7例(12.28%),其中髂动脉破裂1例,血管内支架闭塞2例,股动脉内膜损伤3例,股髂动脉血栓形成1例。术后30 d随访,发生Ⅱ型内漏3例,1例人工血管移植后吻合口狭窄。结论重视术前入路血管的评估,同时掌握腔内及开放手术技巧,有助于正确认识和及时处理血管入路相关并发症,降低EVAR手术风险。Objective To retrospective investigate the causes and analyze the management of early complications of vascular access in endovascular aneurysm repair （EVAR）. Methods A total of 57 patients suffering from abdominal aortic aneurysm （AAA） and undergoing EVAR in our hospital between May 2015 and May 2017 were enrolled in this study. The complications relative to vascular access included rupture of iliac artery, injury of femoral artery intima, occlusion of stent and thrombosis of iliac-femoral artery. Stent graft placement, prosthetic vascular graft transplantation, femorofemoral artery bypass and Fogarty catheter embolectomy were performed respectively to these corresponding complications. Uhrasonography was applied for follow-up of these patients in 30 d after EVAR. Results EVAR procedure was completed successfully in all the cases, without conversions to open surgery. Iliac artery tortuosity, small diameter of femoral artery, unilateral occlusion of iliac artery and iliac aneurysms were present in 7, 3, 4 and 5 cases （2 unilateral and 3 bilateral iliac aneurysms）, respectively in the cohort. Complications associated with vascular access were found in 7 cases （12.28%）, including 1 case of iliac artery rupture, 2 cases of stent occlusion, 3 cases of intimal injury and 1 case of thrombosis in iliac-femoral artery. In 30 d after EVAR, 3 cases of type Ⅱ endoleak and 1 case of anastomotic stenosis in prosthetic vascular graft transplantation occurred. Conclusion Careful assessment of vascular access preoperatively and excellent techniques in both endovascular and open surgery are helpful to recognize and overcome the complications relative to vascular access and to decrease the risk of EVAR.

关 键 词：腹主动脉瘤腔内修复术 血管入路 并发症 

分 类 号：R181.32[医药卫生—流行病学] R619[医药卫生—公共卫生与预防医学]