台上体外开窗腔内动脉瘤修复术治疗短瘤颈腹主动脉瘤的初步观察

Preliminary study of endovascular aneurysm repair using fenestration on table for abdominal aortic aneurysm with short proximal neck

目的 探讨台上体外开窗腔内动脉瘤修复术（FEVAR）治疗短瘤颈腹主动脉瘤的初步研究结果。方法 回顾性分析天津医科大学总医院2015年8月至2016年5月4例应用台上体外开窗EVAR技术治疗的短瘤颈腹主动脉瘤患者的临床资料。所有患者均根据术前CT血管成像（CTA）数据体外自制开窗支架，行腹主动脉瘤腔内修复术及内脏动脉分支支架植入术。结果 4例均顺利完成手术，器械释放成功率100%。术后均无Ⅰ型内漏。2例患者术后1周内出现一过性肾功能损伤，经内科治疗后改善。4例患者平均随访4.7个月（1～9个月）。3例患者术后复查CTA、1例患者术后复查彩色超声多普勒造影均显示腹主动脉主体开窗支架通畅、无内漏、内脏动脉通畅。结论 FEVAR技术的初步研究证实这一技术治疗短瘤颈腹主动脉瘤安全可行，拓展了EVAR适应证，安全性及远期结果需要进一步评估。

Objective To investigate the clinical value of endovascular aneurysm repair（EVAR） using fenestration on table for abdominal aortic aneurysm（AAA） with short proximal neck.Methods A retrospective analysis of four cases with short proximal neck AAA from Aug. 2015 to May. 2016 of Tianjin Medical University General Hospital treated by EVAR using fenestration on table. Fenestrated stent-grafts were designed according to the preoperative computer tomography angiography（CTA） data. All cases underwent EVAR with the fenestrated stent-grafts on table to revascularize visceral branches.Results FEVAR was performed in all of the 4 cases successfully. Device deploying success rate was 100%. No type Ⅰ endoleak was found in all of the 4 cases. Transient renal dysfunction occurred in two cases during 7 post-operative days and improved with the medical treatment. Mean follow-up period was 4.7 months（range, 1-9 months）. CTA （3 cases） and ultrasonic imaging（1 case） were performed postoperatively. No endoleak was found around fenestrated stent graft and patency of visceral stent grafts were maintained in all of the 4 cases. Conclusion EVAR using fenestration on table for short proximal neck AAA is safe and feasible, which expand the indication of EVAR for AAA, and the long-term safety and outcomes of this technique need to be assessed in the future.