摘要
目的评估开窗/分支支架主动脉腔内修复术(fenestrated/branched endovascular aortic repair,f/bEVAR)技术治疗肾周腹主动脉瘤(pararenal abdominal aortic aneurysm,PRA)及Ⅳ型胸腹主动脉瘤(thoracoabdominal aortic aneurysm,TAAA)患者的中期有效性和安全性。方法回顾性分析2012年4月至2021年12月天津医科大学总医院49例利用f/bEVAR技术治疗PRA及Ⅳ型TAAA患者的临床资料。评价有效性指标包括技术成功率、靶血管通畅率、瘤体直径变化;安全性指标包括内漏发生率、肾功能损伤发生率、相关再干预率、死亡率。结果患者重建89条分支动脉,植入101枚分支支架,技术成功率为87.8%(43/49)。1例改为烟囱手术,1例发生Ⅰa型内漏,4例发生Ⅲ型内漏。围术期再干预率为2.0%(1/49),1例因急性髂支闭塞行切开取栓术;无手术相关死亡。患者平均随访(32.0±23.5)个月,内漏患者7例,其中新发4例。相关再干预率为12.8%(6/47),包括Ⅰa型内漏伴腹主动脉瘤破裂1例,Ⅰb型内漏1例,Ⅲ型内漏合并肾动脉支架狭窄/闭塞2例,Ⅱ型内漏2例。1例患者死于腹主动脉瘤破裂,相关死亡率2.1%,无肾功能不全发生。结论f/bEVAR技术治疗PRA及Ⅳ型TAAA的中期随访结果满意,是有效安全的治疗方法。
Objective To evaluate the mid-term effectiveness and safety of the fenestrated/branched endovascular abdominal repair(f/bEVAR)for pararenal abdominal aortic aneurysm(PRA)and typeⅣthoracoabdominal aortic aneurysm(TAAA).Methods The clinical data of 49 patients with PRA and typeⅣTAAA who underwent f/bEVAR at Tianjin Medical University General Hospital from April 2012 to December 2021 were analyzed retrospectively.The effectiveness endpoints included technical success,target patency and sac diameter,and the safety endpoints included endoleaks,impaired renal function,reintervention and mortality.Results A total of 89 branch arteries were reconstructed and 101 branch stents were implanted.The technical success rate was 87.8%(43/49).One patient was conversed to chimney endografts,while one patient occurred typeⅠa endoleak and four patients occurred typeⅢendoleaks.The perioperative reintervention rate was 2.0%(1/49),and one patient underwent thrombectomy due to acute iliac branch occlusion.There was no surgery-related death occurred.Patients were followed up for an average of(32.0±23.5)months,and there were 7 patients of endoleak,including 4 patients of new onset.The related re-intervention rate was 12.8%(6/47),including 1 patient of typeⅠa endoleak with abdominal aortic aneurysm rupture,1 patient of typeⅠb endoleak,2 patients of typeⅢendoleak with renal artery stent stenosis/occlusion,2 patients of typeⅡendoleak.One patient died of ruptured abdominal aortic aneurysm,and the related mortality rate was 2.1%.There was no renal insufficiency occurred.Conclusion The medium-term results of f/bEVAR in the treatment of PRA and typeⅣTAAA are satisfactory,and it is an effective and safe treatment.
作者
陈永辉
秘家学
刘宗伟
张晓星
王帅帅
戴向晨
Chen Yonghui;Mi Jiaxue;Liu Zongwei;Zhang Xiaoxing;Wang Shuaishuai;Dai Xiangchen(Department of Vascular Surgery,Tianjin Medical University General Hospital,Tianjing 300070,China)
出处
《中国血管外科杂志（电子版）》
2022年第4期309-313,共5页
Chinese Journal of Vascular Surgery(Electronic Version)
基金
国家自然科学基金面上项目(82070489)
天津市自然科学基金青年项目(19JCQNJC09900)
天津市滨海新区卫生健康委科技项目(2019BWKQ037)
天津医科大学总医院青年孵育基金项目(ZYYFY2019014)。
关键词
肾周腹主动脉瘤
胸腹主动脉瘤
开窗技术
分支支架
腔内修复术
内漏
Pararenal abdominal aortic aneurysm
Thoracoabdominal aortic aneurysm
Fenestrated
Branch stent
Endovascular surgery
Endoleak
