开窗及分支支架技术治疗胸腹主动脉瘤的中期随访结果  

Mid term results of fenestrated branch stent technique for the treatment of thoracoabdominal aortic aneurysms

作　　者：项广源 叶盛麟 杜晓龙 于同[2] 李文东 张业鹏[2] 刘昭[2] 乔彤[2] 周敏[2] 李晓强 Xiang Guangyuan;Ye Shenglin;Du Xiaolong;Yu Tong;Li Wendong;Zhang Yepeng;Liu Zhao;Qiao Tong;Zhou Min;Li Xiaoqiang(Department of Vascular Surgery,Gulou Medical School,Jiangsu University,Nanjing 210008,China;Department of Vascular Surgery,Drum Power Hospital,School of Medicine,Nanjing University,Nanjing 210008,China)

机构地区：[1]江苏大学鼓楼临床医学院血管外科,南京210008 [2]南京大学医学院附属鼓楼医院血管外科,南京210008

出　　处：《中华普通外科杂志》2023年第7期486-490,共5页Chinese Journal of General Surgery

摘　　要：目的探讨应用开窗及分支支架主动脉腔内修复术(fenestrated/branched endovascular aortic repair,f/b EVAR)治疗胸腹主动脉瘤患者的中期随访结果。方法对2018至2019年于南京鼓楼医院血管外科行f/b EVAR治疗的105例患者的临床资料进行回顾性分析,其中胸腹主动脉真性动脉瘤43例,胸腹主动脉夹层动脉瘤62例。结果共重建分支动脉336条,技术成功率94.3%。100例(95.2%)患者获得随访,其中再次手术干预6例(5.7%),死亡11例(10.5%)。随访期有完整影像学资料患者69例:以最近一次胸腹主动脉CT为基准,主动脉正性重塑患者58例,负性及不确定重塑患者11例;存在内漏31例(29.5%),包括Ⅰb型7例(6.7%),Ⅱ型8例(7.6%),Ⅲa型1例(0.95%),Ⅲc型13例(12.4%),Ⅳ型2例(1.9%)。结论应用f/b EVAR技术治疗TAAA中期随访结果满意,降低内漏的发生率是f/b EVAR的技术难点。Objective To evaluate the mid-term results of fenestrated/branched endovascular aortic repair(f/b EVAR)for the treatment of thoracoabdominal aortic aneurysms.Methods The clinical data of 105 thoracoabdominal aortic aneurysm patients treated with f/b EVAR at the Department of Vascular Surgery of Nanjing Drum Tower Hospital from 2018 to 2019 were retrospectively analyzed.Results There were 43 cases of thoracoabdominal aortic aneurysm and 62 cases of thoracoabdominal aortic aissection.A total of 336 branch arteries were reconstructed,and technical success rate was 94.3%.100 cases(95.2%)were followed-up,6 cases(5.7%)received reoperation interventions,and 11 cases(10.5%)died.During the follow-up period,69 cases had complete imaging data.Based on the recent CT date of the thoracoabdominal aorta,58 patients hael positive aortic remodeling and 11 patients hael negative and indeterminate remodeling;there were 31 cases(29.5%)of endoleaks,including 7 cases(6.7%)of typeⅠb endoleaks,8 cases(7.6%)of typeⅡ,1 case(0.95%)of typeⅢa,13 cases(12.4%)of typeⅢc endoleaks and 2 cases(1.9%)of typeⅣ.Conclusions The mid-term follow-up results were satisfactory for TAAA treated with f/b EVAR.Internal leakage remains key point for f/b EVAR.

关 键 词：主动脉瘤 胸 主动脉瘤 腹 支架 内漏 

分 类 号：R654.4[医药卫生—外科学]