主动脉疾病专题研究(Monographic Study of Aortic Diseases)

腔内修复术在复杂型肾下腹主动脉瘤中的应用

Published at: 2015年第24卷第12期

孙凯 1 , 胡何节 2
1 安徽医科大学附属六安医院 普外四科,安徽 六安 237005
2 安徽医科大学附属省立医院 血管外科,安徽 合肥230001
通讯作者 何节 胡 Email: hu.hejie@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.12.004
基金:
安徽省自然科学基金资助项目 1408085MH177

摘要

目的:探讨对于复杂型肾下腹主动脉瘤(AAA)行腔内修复(EVAR)治疗的操作要点和治疗效果。 方法:回顾行EVAR 治疗的15 例复杂型肾下AAA 患者的临床资料,分析术中操作要点和临床结局。 结果:手术技术成功率为100%,无中转开腹病例,1 例(6.67%)术后5 d 死于急性心衰。瘤颈成角 过大2 例患者均使用肱- 股双导丝技术完成手术;髂动脉狭窄患者7 例,4 例利用肱- 股双导丝技术 及球囊扩张后置入支架,其余经球囊扩张完成操作;1 例左髂动脉闭塞的患者采用对侧髂动脉进入导 丝通过闭塞段完成手术;8 例重度扭曲患者通过超硬导丝将扭曲段纠正后释放支架。术中无瘤体破裂、 血管穿孔及医源性血管夹层等严重并发症出现。随访期间,1 例患者术后2 年出现腰椎结核,死于多 脏器功能衰竭;内漏3 例,二次手术干预1 例。 结论:随着经验的积累,技术的进步及支架的不断完善,EVAR 治疗复杂型肾下AAA 是可行、有效的。


Endovascular repair for complex infra-renal abdominal aortic aneurysm

Abstract

Objective: To investigate the technical essentials and efficacy of endovascular aortic repair (EVAR) in treatment of complex infra-renal abdominal aortic aneurysm (AAA). Methods: The clinical data of 15 patients with complex infra-renal AAA undergoing EVAR were reviewed, and the technical essentials and clinical outcomes were analyzed. Results: The technical success rate of the operation was 100%, without any open conversion. One patient (6.67%) died of acute heart failure 5 days after EVAR. In 2 patients with severe angulation of aneurysmal neck, the operation was completed by brachial-femoral guidewire insertion; in 7 patients with iliac artery stenosis, 4 cases underwent brachial-femoral guidewire insertion and stent placement after balloon dilatation, and in the remaining cases operation was completed by balloon dilatation only; one patient with left iliac artery occlusion was recanalized by leading the guidewire through the occluded segment from the contralateral iliac artery; 8 patients with severe iliac artery distortion underwent correction of the distorted segment by super-hard guide wire and then had stent deployment. No serious complications such as aneurysmal rupture, vascular penetration and iatrogenic dissection occurred during operation. During follow-up, one patient developed spinal tuberculosis 2 years after the surgery and died of multiple organ failure, endoleak occurred in 3 patients and one patient received a second surgical intervention. Conclusion: With the accumulation of experience, technical progress and continued stent development, EVER is feasible and effective therapy for complex infra-renal AAA.


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引用

引用本文: 凯 孙, 何节 胡. 腔内修复术在复杂型肾下腹主动脉瘤中的应用[J]. 中国普通外科杂志, 2015, 24(12): 1658-1663.
Cite this article as: SUN Kai, HU Hejie . Endovascular repair for complex infra-renal abdominal aortic aneurysm[J]. Chin J Gen Surg, 2015, 24(12): 1658-1663.