破裂性腹主动脉瘤的腔内治疗进展  

Progresses of endovascular aortic repair in ruptured abdominal aortic aneurysm

作　　者：王嘉宾 马天峰 郭伟 Wang Jiabin;Ma Tianfeng;Guo Wei(Department of Vascular Surgery,the First Medical Centre,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心血管外科,北京100853

出　　处：《血管与腔内血管外科杂志》2021年第6期654-658,663,共6页Journal of Vascular and Endovascular Surgery

基　　金：国家重点研发计划(2020YFC1107701);首都卫生发展科研专项(首发2020-2Z-5014)。

摘　　要：破裂性腹主动脉瘤(RAAA)是血管外科的急症之一,病死率可高达90%。RAAA易被误诊,计算机断层扫描血管造影(CTA)影像技术既可确诊RAAA,又可对破裂血管进行三维重建,对治疗RAAA具有指导意义,是指南推荐的诊断方法。随着早期相关随机对照试验结果的公布,腹主动脉瘤腔内修复术(EVAR)在RAAA治疗中的应用已经发生改变。在最新的指南中,EVAR已被推荐作为解剖条件合适的RAAA患者的首选治疗方式。但对于复杂情况(如高龄、血流动力学不稳定、复杂解剖动脉瘤)的RAAA行腔内治疗的经验仍存在不足。随着越来越多RAAA患者接受腔内治疗,血管外科医师对EVAR术后相关并发症的监测和管理意识也需进一步加强。本文基于RAAA腔内修复技术治疗进展的相关文献,对RAAA的腔内治疗现状进行分析和总结。Ruptured abdominal aortic aneurysm(RAAA)is an emergency disease in vascular surgery,with mortality up to 90%.RAAA can be misdiagnosed,but computed tomography angiography(CTA)is recommended since it can be applied to diagnose RAAA and used to reconstruct three-dimensional graphs of aorta,which is useful to indicate treatment;CTA is the diagnostic method recommended by the guidelines.With the publication of the results of earlier randomized controlled trails,the application of endovascular aortic repair(EVAR)in the treatment of patients with RAAA has changed.In the last guidance of AAA,EVAR has been recommended for the treatment of a ruptured AAA over open repair if patients'anatomies are suitable.However,there remains limited experience of EVAR in treatment RAAA patients who are elderly,hemodynamically unstable or with hostile anatomy.Because more and more EVAR have been applied,vascular surgeons should also arise more awareness to postoperative complications of EVRA.Based on the literatures about EVRA in repairing RAAA,the progresses of EVRA in repairing RAAA were summarized and analyzed.

关 键 词：破裂性腹主动脉瘤 腹主动脉腔内修复术 主动脉破裂 

分 类 号：R543[医药卫生—心血管疾病]