经股动脉逆向支架外栓塞补救腹主动脉腔内修复术中内漏的单中心经验  

Transfemoral retrograde perigraft embolization of endoleaks during endovascular aortic repair:A single-center experience

作　　者：张喆[1] 连利珊[1] 冯海[1] 陈学明[1] Zhang Zhe;Lian Lishan;Feng Hai;Chen Xueming(Department of Vascular Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院血管外科,北京100050

出　　处：《中国血管外科杂志（电子版）》2024年第3期232-236,共5页Chinese Journal of Vascular Surgery(Electronic Version)

摘　　要：目的探索腹主动脉腔内修复术(endovascular aortic repair,EVAR)中经股动脉逆向支架外瘤腔内栓塞内漏的有效性和安全性。方法回顾性分析2021年12月至2023年10月首都医科大学附属北京友谊医院11例EVAR术中经股动脉逆向瘤腔内栓塞补救内漏的患者临床资料,其中包括8例Ⅰ型内漏和3例Ⅱ型内漏。内漏均通过瘤腔内弹簧圈栓塞或联合液体栓塞剂处理,并在随访期间定期接受CT血管造影(computed tomography angiography,CTA)随访。结果9例单纯使用弹簧圈栓塞,2例使用弹簧圈辅助生物蛋白胶及凝血酶散栓塞,造影见8例内漏完全消失、3例内漏明显减少。术中1例出现生物蛋白胶异位栓塞,其余患者无相关并发症发生。术后随访6~24个月,平均随访时间(10.4±5.4)个月,CTA复查结果显示无明确内漏发生,6例瘤体直径较前减小,5例直径无变化,随访期间无再次手术及死亡发生。结论经股动脉逆向支架外栓塞可补救EVAR术中Ⅰ型或Ⅱ型内漏,短期疗效满意。Objective To explore the efficacy and safety of transfemoral retrograde perigraft embolization of endoleaks during endovascular aortic repair(EVAR).Methods The clinical data of 11 patients who underwent transfemoral retrograde perigraft embolization of endoleaks during EVAR at Beijing Friendship Hospital,Capital Medical University from December 2021 to October 2023 were analyzed retrospectively,including 8 cases of typeⅠendoleak and 3 cases of typeⅡendoleak.All endoleaks were treated by endoluminal coil embolization or combined with liquid embolic agent,and computed tomography angiography(CTA)was performed regularly in the follow-up.Results Nine cases were treated with coil embolization alone,and two cases were treated with coil embolization combined with fibrin sealant and thrombin.Angiography showed that the endoleak completely disappeared in 8 cases and significantly reduced in 3 cases.One case had ectopic embolization of bioprotein glue during the operation,and no related complications occurred in the other patients.The patients were followed-up for 6 to 24 months after EVAR,with an average follow-up time of 10.4±5.4 months.No endoleak recurrence was found in the results of CTA.The diameter of the aneurysm decreased in 6 cases,and kept stability in 5 cases.No reintervention or death occurred during the follow-up period.Conclusion Transfemoral retrograde perigraft embolization can remedy typeⅠor typeⅡendoleak during EVAR,with satisfactory short-term efficacy.

关 键 词：腹主动脉腔内修复术 主动脉瘤 栓塞 内漏 

分 类 号：R654.3[医药卫生—外科学]