摘要
目的探讨腹主动脉腔内修复术(endovascular aortic repair,EVAR)治疗腹主动脉瘤术后髂支闭塞的原因及治疗方法。方法回顾性分析2010年1月至2020年1月南京医科大学第一附属医院14例EVAR治疗腹主动脉瘤术后髂支闭塞患者的临床资料,总结闭塞原因及处理方法。结果髂支闭塞原因包括髂支远端与髂外动脉成角狭窄导致闭塞5例,髂支受压狭窄5例,髂支打折3例,髂支放大率过大导致狭窄闭塞1例。治疗方法包括保守治疗1例,股动脉切开取栓和/或支架植入9例,股动脉-股动脉转流4例,患者的症状均得到改善或消失。患者术后中位随访时间24个月(4~81个月),下肢缺血症状均无复发或加重。结论导致EVAR术后髂支闭塞的主要原因包括髂支远侧释放至髂外动脉、髂动脉扭曲、狭窄等。髂支闭塞的治疗方法包括保守治疗、切开取栓+支架植入、股动脉-股动脉旁路等,均具有较好的近中期疗效。
Objective To investigate the causes and treatment of limb graft occlusion after endovascular aortic repair(EVAR)of abdominal aortic aneurysm.Methods The clinical data of 14 patients with limb graft occlusion after EVAR in the First Affiliated Hospital of Nanjing Medical University from January 2010 to January 2020 were analyzed retrospectively,and the causes and treatment methods of limb graft occlusion were summarized.Results The causes of occlusion included angular stenosis between the distal end of the iliac branch and the external iliac artery(5 cases),iliac branch compressed(5 cases),iliac branch kinking(3 cases)and too large of iliac branch oversize(1 case).The treatment methods included conservative treatment(1 case),femoral artery thrombectomy and/or stent implantation(9 cases)and femorofemoral bypass(4 cases).The symptoms of all patients were improved or disappeared.The median follow-up time of the patients was 24 months(4-81 months),and there was no recurrence or aggravation of lower extremity ischemia symptoms.Conclusion The main factors that lead to limb graft occlusion include extended iliac branch to external iliac artery,iliac artery torsion and stenosis.The treatment of iliac branch occlusion includes conservative treatment,thrombectomy and stent implantation and femorofemoral bypass,which have good short-term and mid-term effects.
作者
邹君杰
焦元勇
缪苏宇
章希炜
杨宏宇
马昊
陈海滨
Zou Junjie;Jiao Yuanyong;Miao Suyu;Zhang Xiwei;Yang Hongyu;Ma Hao;Cheng Haibing(Department of Vascular Surgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《中国血管外科杂志（电子版）》
2022年第1期27-31,共5页
Chinese Journal of Vascular Surgery(Electronic Version)
基金
江苏省卫生健康委员会医学科研课题面上项目(H2017021)。
关键词
腹主动脉瘤
腔内治疗
髂支闭塞
病因
治疗
Abdominal artery aneurysm
Endovascular aortic repair
Limb graft occlusion
Etiology
Treatment
