三明治技术在腹主动脉瘤累及髂总动脉腔内治疗中保留髂内动脉的疗效分析  

Application of sandwich technique in preserving internal iliac artery during endovascular treatment for abdominal aortic aneurysm involving common iliac artery:analysis of curative effect

作　　者：何拯 颜海燕[1] 付健[1] 孙建明[1] HE Zheng;YAN Haiyan;FU Jian;SUN Jianming(Department of Abdominal Vascular Surgery,Second Affiliated Hospital,Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院腹壁血管外科,400010

出　　处：《介入放射学杂志》2020年第5期449-452,共4页Journal of Interventional Radiology

摘　　要：目的分析三明治技术应用于腹主动脉瘤(AAA)累及髂总动脉腔内治疗保留髂内动脉的近期疗效。方法回顾性分析重庆医科大学附属第二医院2016年6月至2018年7月采用主动脉腔内修复术(EVAR)治疗的9例AAA累及髂总动脉患者(累及单侧髂总动脉3例,双侧6例),术中均接受髂内动脉三明治重建。术后观察和随访围手术期死亡率、腔内修复效果、内漏、支架一期通畅情况及手术相关并发症发生情况。结果9例患者EVAR术和髂内动脉三明治重建技术均获成功,围手术期无死亡。术中即刻造影显示9例支架均获通畅,瘤腔均成功修复。出现1例Ⅰ型内漏,2例Ⅲ型内漏,随访时自行消失;1例左上肢急性缺血,再次予急诊肱动脉修复术;3例左肱动脉切口处血肿形成,2例右股动脉穿刺点处血肿形成。术后1周、3个月、6个月复查CTA分别显示支架通畅9例、8例、8例,均无肠缺血、脊髓缺血或瘫痪症状。结论三明治技术在AAA累及髂总动脉腔内治疗中保留髂内动脉安全可行,术后臀肌跛行发生率低,近期随访支架通畅率可,值得临床推广,但远期效果尚需进一步随访及更大临床样本验证。Objective To analyze the short-term curative effect of sandwich technique in preserving internal iliac artery during endovascular treatment for abdominal aortic aneurysm(AAA) involving common iliac artery. Methods The clinical data of 9 patients with AAA involving common iliac artery, who were admitted to the Second Affiliated Hospital of Chongqing Medical University of China during the period from June 2016 to July 2018 to receive endovascular aortic repair(EVAR), were retrospective analyzed. Of the 9 patients, unilateral involvement of common iliac artery was seen in 3 and bilateral involvement of common iliac artery was seen in 6. During EVAR, reconstruction of internal iliac artery by using sandwich technique was carried out in all patients. All patients were followed up. The perioperative mortality, the curative effect of EVAR, the endoleak, the primary stent patency and the procedure-related complications were recorded.Results Successful EVAR and reconstruction of internal iliac artery with sandwich technique were accomplished in all 9 patients. No death occurred during perioperative period. Intraoperative immediate angiography showed that the stent patency rate was 100%, and the aneurysm cavity was successfully repaired in all patients. One patient developed type Ⅰ leak and 2 patients developed type Ⅲ leak, which disappeared spontaneously during follow-up period. Acute ischemia of left upper limb occurred in one patient and emergency repair of brachial artery had to be carried out. Hematoma formation at the incision of the left brachial artery was seen in 3 patients, and hematoma formation at the puncture point of the right femoral artery was seen in 2 patients. Reexamination of CT angiography was performed at one week, 3 months and 6 months after EVAR, which demonstrated that the stent patency were 9 cases,8 cases and 8 cases respectively.No symptoms of intestinal ischemia, spinal cord ischemia or paralysis were observed in all patients.Conclusion In performing EVAR for AAA involving common iliac arte

关 键 词：三明治技术 腹主动脉瘤 髂内动脉 

分 类 号：R543.15[医药卫生—心血管疾病]