巨大腘动脉瘤血管腔内修复1例报告并文献复习  

Endovascular repair of giant poplitealartery aneurysms: a case report and literature review

作　　者：张宁[1] 田宇 蔡汉鑫 黄智勇 ZHANG Ning;TIAN Yu;CAI Hanxin;HUANG Zhiyong(The Third Affiliated Hospital of Shenzhen University,Shenzhen 518000,China)

机构地区：[1]深圳大学第三附属医院,广东深圳518000

出　　处：《临床医药实践》2022年第6期441-444,共4页Proceeding of Clinical Medicine

摘　　要：目的:报告1例多发性周围动脉瘤患者合并右腘动脉巨大动脉瘤的治疗及随访结果,并复习相关文献。方法:通过血管腔内修复,成功治疗1例巨大腘动脉瘤患者,并通过文献复习,比较开放手术(OR)及血管腔内修复(EVR)在腘动脉瘤(PAAs)治疗中的安全性及有效性。结果:患者接受置管溶栓术后使用覆膜支架(GORE-Viabahn)行血管腔内修复,术后3个月的CT血管造影(CTA)随访显示,支架血流通畅,动脉瘤腔大小不变,无造影剂外渗。18个月CTA随访显示:支架内血栓形成,动脉瘤腔明显减小,无造影剂外渗,给予置管溶栓及球囊扩张后恢复血流通畅。文献回顾显示:通过OR治疗患者的原发通畅率明显高于EVR治疗的患者,且30 d内移植物血栓形成和再干预的发生率也明显低于EVR治疗患者。而接受EVR治疗患者的手术时间和住院时间明显缩短,且两种术式患者的截肢率比较,差异无统计学意义(P>0.05)。结论:通过EVR修复PAAs是一种安全有效的手术方式,但仍面临短期内移植物血栓形成及再干预的问题。开放手术仍是治疗PAAs的一线选择。血管腔内修复作为一个有价值的替代选择,仍需进一步监测血管腔内修复后移植物的通畅度。Objective: To report the treatment and follow-up results of a patient with a multiple peripheral aneurysm complicated with a giant right popliteal artery aneurysm and to review the relevant literature.Methods: We treated one patient with a giant popliteal aneurysm by endovascular repair.And the safety and effectiveness of open repair(OR) and endovascular repair(EVR) in the treatment of popliteal artery aneurysms(PAAs) were compared through the literature review.Results: The patient underwent endovascular repair with GORE-Viabahn stent.A 3-monthfollow-up CTA(computed tomography angiography)demonstrated biphasic flow in a patent stent-graft with an unchanged aneurysm sacsize and no evidence of an endoleak.The 18-month follow-up CTA showed: stent thrombosis with a significantly reduced aneurysm sacsize and no evidence of an endoleak, and restore blood flow after catheter-directed thrombolysisand percutaneous transluminal angioplasty.A review of the literature showed that the primary patency rate was significantly higher in the patients treated with OR than in those treated with EVR,and the incidence of graft thrombosis and reintervention was also significantly lower than in patients treated with EVR.However, the surgical time and hospitalization were significantly shorter in patients receiving EVR,and there was no significant difference in the amputation rate between the two surgical patients.Conclusion: Repairing PAAs through EVR is a safe and effective procedure, but it still faces the problem of graft thrombosis and reintervention in the short term.A review of the literature indicates that open surgery is still a first-line option for treating PAAs, endovascular repair as a valuable alternative, still requires further monitoring of plant patency after endovascular repair.

关 键 词：腘动脉瘤 腔内治疗 文献回顾 

分 类 号：R543.5[医药卫生—心血管疾病]