目的： 探讨腹主动脉瘤（AAA）腔内修复术（EVAR）中输送器回撤困难的原因处理对策。方法：回顾性分析2008年1月—2016年4月305例行EVAR的AAA患者临床资料，分析术中输送器回撤困难发生的原因及相应对策。结果：305例患者中，共21例（6.89%）出现输送器回撤困难，其中复杂AAA 18例，非复杂AAA 3例；分体式支架修复17例，一体化支架修复4例，差异均有统计学意义（85.7% vs. 14.3%；81.0% vs. 19.0%，均P<0.05）。18例出现回撤困难复杂AAA患者均存在瘤颈严重扭曲，其中7例存在2个以上连续扭曲瘤颈，2例扭曲同时伴有短瘤颈；在所有存在扭曲瘤颈的患者中，有2个以上连续扭曲瘤颈患者回撤困难的发生率最高（P<0.05）。21例回撤困难情况通过综合运用相关处理对策均成功解决。结论：复杂AAA的EVAR发生输送器回撤困难情况并不少见，尤其是存在2个以上连续扭曲瘤颈的更易发生，通过综合运用相应对策可有效处理。
Strategies for managing difficulties in withdrawal of delivery system during endovascular aneurysm repair of abdominal aortic aneurysm
Objective: To investigate the causes for difficulties in withdrawal of delivery system during endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) and solutions. Methods: The clinical data of 305 AAA patients undergoing EVAR from January 2008 to April 2016 were retrospectively analyzed. The causes for occurrence of the difficulties during delivery system withdrawal and corresponding solving strategies were analyzed. Results: Among the 305 patients, difficulties of delivery system withdrawal occurred in 21cases (6.89%), of whom, 18 cases were complex AAA and 3 cases were non-complex AAA; 17 cases were repaired with bifurcated stent grafts and 4 cases with unibody bifurcated stent grafts, and both differences had statistical significance (85.7% vs. 14.3%; 81.0% vs. 19.0%, both P<0.05). All the 18 patients with complex AAA who encountered difficulties of delivery system withdrawal had severe aneurysmal neck angulation, of whom, 7 cases had more than 2 successive aneurysmal neck angulations and 2 cases had concomitant short aneurysmal neck. Among patients with aneurysmal neck angulations, those with more than 2 successive aneurysmal neck angulations had the highest incidence of difficulties of delivery system withdrawal (P<0.05). All withdrawal difficulties were successfully resolved by comprehensive application of corresponding countermeasures. Conclusion: Difficulties in withdrawal of the delivery system are not uncommon during EVAR for complex AAA, especially for those with multiple aneurysmal neck angulations. However, the difficulties can be effectively resolved by comprehensive application of corresponding countermeasures.