摘要
目的探讨近端锚定区不良的腹主动脉瘤腔内治疗方案选择，并评价其临床疗效。方法对2010年1月至2012年6月于解放军总医院血管外科接受覆膜支架治疗近端锚定区不良的51例腹主动脉瘤患者临床资料进行回顾性分析。男44例，女7例；年龄42～94岁，平均73岁。病变动脉瘤直径32～100mm，瘤颈长度0～50mm，宽度15—40mm，成角15—80°，瘤颈钙化10例，附壁血栓15例，不规则瘤颈5例。结果支架主体选择Endurant9例、Talent5例、Zenith31例、Hercules5例，延长支架Palmaz／CUFF6例，“多层裸”支架2例。特殊器材和技术包括“开窗”支架11例和“烟囱”技术31例，累及肾动脉39根、肠系膜上动脉3根、腹腔干动脉3根。手术成功率100％，围手术期内漏发生率17．6％。随访时间2～28个月（中位值13个月），随访期间支架血管移植物通畅率96．1％，瘤腔血栓化率82．4％，持续性I型内漏3例，新发内漏2例，均成功进行二次介入干预，支架移位3例，移植距离均〈10mm，无新发死亡和感染病例，未见支架内闭塞、下肢缺血、瘤体扩张和破裂等并发症。结论多种腔内技术方案可用于治疗近端锚定区不良的腹主动脉瘤，且具有良好的近期临床效果。
Objective To explore the option and efficacy of endovascular aneurysm repair （EVAR） for abdominal aortic aneurysm （AAA） with hostile aortic proximal landing anatomy. Methods The clinical data of 51 AAA patients with hostile aortic proximal landing anatomy treated by EVAR from January 2010 to June 2012 at our hospital was retrospectively analyzed. There were 44 males and 7 females with a mean age of 73 years （range ：42 -94）. The anatomic measurements included a diameter of aneurysm body 32 - 100 mm, a length of proximal neck 0 - 50 ram, a width of proximal neck 15 - 40 mm and infrarenal angulation 15 - 80 degrees. In addition, there were calcification （n = 10） and thrombus lining with aortic neck （n = 15 ） and irregular shape of aortic neck （n = 5 ） respectively. The stent-grafts were deployed by 4 femoral arteries. Results Many types of aortic stent were used, such as Endurant （n = 9）, Talent （n = 5 ）, Zenith （ n = 31 ）, Hercules （n = 5 ）, Palmaz/CUFF （ n = 6 ） and multilayer bare-stent （ n = 2 ）. And 11 patients underwent fenestrated EVAR and 31 with chimney EVAR involving renal artery （39 branches）, superior mesenteric artery （3 branches） and celiac trunk （3 branches）. The primary technical success rate was 100%. The perioperative endoleak rate was 17.6%. During the mean follow-up period of 13 months （2 - 28）, the primary patency of stent was 96. 1% and the thrombus rate of aneurysm 82. 4%. Two cases of new endoleak and 3 cases of residual endoleak underwent secondary intervention. In addition, long-term follow-up was required for 3 patients with stent-graft migration （ 〈 10 mm）. There was no case of death, infection, occlusions, ischemia of lower limbs, aneurysm expansion or rupture. Conclusion A variety of EVAR options are both safe and efficacious in the treatment of AAA with hostile proximal landing zone.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第47期3329-3332,共4页
National Medical Journal of China
关键词
腹主动脉瘤
腔内修复术
支架
Abdominal aortic aneurysm
Endovascular aneurysm repair
Stent-graft
