支架植入预防腹主动脉瘤腔内修复术后髂支血栓形成的疗效研究

The stent implantation reducing the risk of iliac limb occlusions following endovascular abdominal aortic aneurysm repair

目的探讨裸支架植入对于腹主动脉瘤腔内修复(EVAR)术后髂支血栓形成的预防效果。方法 2005年1月～2010年12月,我院共实施322例EVAR术。为预防支架内闭塞的发生,根据血管造影并结合术前CT血管造影(CTA)检查评估,42例患者EVAR术中行裸支架植入,通过术后血管彩超及增强CT检查定期随访患者中期支架通畅率。结果 EVAR术技术成功率为100%,均应用分叉型支架型人工血管,其中不锈钢支架26例(61.9%),镍钛记忆合金支架16例(38.1%)。42例EVAR术中行裸支架植入的患者中,围手术期死亡率7.1%(3/42),髂支血栓形成1例,其余患者均恢复顺利出院。平均随访时间(15.4±8.7)个月,随访期间死亡率5.1%(2/39),髂支血栓形成1例。支架总体通畅率为94.9%(37/39)。结论通过术中多角度血管造影结合术前CTA检查结果,裸支架植入有助于预防EVAR术后髂支血栓形成。

Objective To explore the effect of reducing the incidence of iliac limb occlusion after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm with naked stent, retrospectively in a single medical center. Methods From Jan. 2005 to Dec. 2010, 322 patients underwent EVAR. According to the results of the three -projection completion angiography and pre -operative computed tomography angiography(CTA) scans,.naked stents were placed into endograft limbs in 42 cases at the time of EVAR to prevent stent occlusion. All patients were followed up with CTA scans and duplex for the stent patency. Results The technical success rate was 100%. All cases were used the bifurcated stent -graft system, including stainless steel stent-graft in 26 cases (61.9%) and nitinol stent-graft in 16 cases (38.1%). Among 42 cases with naked stent implantation, the mortality was 7.1% (3 / 42), and iliac limb occlusion occurred in one patient during the perioperative period. The average follow-up time was (15.4±8.7)months. The mortality was 5.1% (2 / 39) and iliac limb occlusion occurred in one patient during the follow-up time. The overall patency rate of endograft limb was 94.9%(37 / 39). Conclusion A strategy of naked stent implantation based on multiplanar completion angiography combined with preoperative CTA assessment appears to reduce the incidence of stent limb occlusion after EVAR.