专题研究(Monographic Study)

腹主动脉瘤腔内修复术后髂支支架内闭塞的危险因素分析

Published at: 2016年第25卷第6期

陈洪胜 1 , 郭媛媛 2 , 彭飞 2 , 魏广源 2
1 山东省菏泽市单县东大医院 普外三科,山东 菏泽 274300
2 昆明医科大学第一附属医院 血管外科,云南 昆明 650032
通讯作者 媛媛 郭 Email: guoyuanyuanxy@126.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.06.008
基金:

摘要

目的:探讨腹主动脉瘤腔内修复术(EVAR)后髂支支架内闭塞的危险因素。方法:收集2011年1月—2015年12月行EVAR的腹主动脉瘤患者的临床资料,采用1:3配比病例对照方法,每个发生髂支支架内闭塞的病例随机选择3例同性别、年龄±3岁、使用同厂家的同种类型支架未发生髂支支架内闭塞的患者为对照,对EVAR后髂支支架内闭塞危险因素行单因素和多因素Logistic回归分析。结果:共495例腹主动脉瘤患者行EVAR,11例(2.2%)发生髂支支架内闭塞。术后发生髂支支架内闭塞的平均时间为2~20周。单因素分析显示,术前髂动脉扭曲成角≥60°(P=0.001),术前髂动脉狭窄≥50%(P=0.002),髂支支架远端口径放大率>15%(P=0.004)等因素与EVAR后髂支支架内闭塞有关;Logistics回归分析显示,以上述因素均为EVAR后髂支支架内闭塞的独立危险因素(均P<0.05)。结论:术前根据髂动脉解剖特性严格制定计划,选择合适的支架口径是减少术后髂支内闭塞的关键。应识别高危人群,针对可控因素采取预防措施,以避免及减少术后支架内闭塞的发生。


Analysis of risk factors for iliac limb occlusion after endovascular repair of abdominal aortic aneurysm

Abstract

Objective: To analyze the risk factors for iliac limb occlusion after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm. Methods: The clinical data of patients with abdominal aortic aneurysm undergoing EVAR between January 2011 and December 2015 were collected. By a 1:3 matched case-control design, for each case with iliac limb occlusion, 3 patients of the same sex, age (within 3 year), and receiving stent of the same type and same manufacturer were randomly selected as control. The risk factors for iliac limb occlusion after EVAR were determined by univariate and multivariate Logistic regression analysis. Results: A total of 495 patients with abdominal aortic aneurysm underwent EVAR, among them, 11 cases (2.2%) developed iliac limb occlusion, and the average time to onset was 2-20 weeks after surgery. Univariate analysis showed that preoperative iliac artery angulation/tortuosity≥60° (P=0.001), preoperative iliac artery stenosis≥50% (P=0.002) and graft oversizing of the distal end of the iliac limb>15% (P=0.004) were significantly associated with post-EVAR iliac limb occlusion. Multivariate Logistic regression analysis revealed that all the above variables were independent risk factors for post-EVAR iliac limb occlusion (all P<0.05). Conclusion: Rigorous preoperative surgical plan based on the anatomic features of the iliac artery and selection of appropriate stent size are critical for reducing postoperative iliac limb occlusion. The high-risk patients should be identified and preventive measures of the controllable factors should be taken to avoid or reduce the occurrence of postoperative iliac limb occlusion.


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引用

引用本文: 洪胜 陈, 媛媛 郭, 飞 彭, 广源 魏. 腹主动脉瘤腔内修复术后髂支支架内闭塞的危险因素分析[J]. 中国普通外科杂志, 2016, 25(6): 828-832.
Cite this article as: CHEN Hongsheng, GUO Yuanyuan, PENG Fei, WEI Guangyuan . Analysis of risk factors for iliac limb occlusion after endovascular repair of abdominal aortic aneurysm[J]. Chin J Gen Surg, 2016, 25(6): 828-832.