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
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.