腹主动脉瘤的血管腔内治疗

Endovascular stent-graft treatment for abdominal aortic aneurysm

目的探讨腹主动脉瘤(AAA)血管腔内治疗后的短期临床效果。方法回顾性分析2009年4月～2010年7月我科收治的8例AAA患者的临床资料。结果患者均接受血管腔内治疗,手术成功率7/8,死亡1人。5例植入分叉型支架,2例植入直型支架,1例支架释放不成功。1例术后第2天右髂动脉支架折叠成角,远端血栓形成,给予局部溶栓成功后第3天血栓再次形成,急诊行左股-右股动脉旁路转流术。1例术后第2天出现急性肾功能不全,2个月后出现结肠缺血表现,给予对症治疗后好转。1例术中主体支架释放不成功,急诊行开腹手术,取出支架,行AAA修补术,术后第2天因呼吸循环衰竭死亡。随访1～16个月,中位随访时间5个月,至最后一次随访(死亡)时止,无内漏发生,无支架明显移位及动脉瘤腔内血栓形成。结论 AAA血管腔内治疗后的短期临床疗效满意,远期疗效有待进一步随访。

Objective To investigate the short-term efficacy of endovascular stent-graft treatment for abdominal aortic aneurysm. Methods From April 2009 to July 2010, endovascular aortic repair was performed on 8 patients. Results The operation was performed successfully on 7(7/8) cases, including 5 cases with bifurcated aorta-iliac stent-grafts, 2 with tubular stent-grafts, and one case (1/8)died. The right iliac leg stent of one patient angulated and distal end of stent thrombosis occurred on the second day after surgery. The patient recovered after local thrombolysis, but stent thrombosis occurred again 3 days later, so left-right femoral artery bypass was performed emergently. One case presented acute renal insufficiency and colonic ischemia on the second day and at 2-month after operation, respectively, and improved after symptomatic treatment. Stent-graft failed to release in one case, and emergency open surgery was performed to remove stent, the patient died of respiratory and circulatory failure on the second day after operation. During the follow-up time with 1～16 (median, 5) months, there were no endoleak, graft migration and thrombosis in aneurysm cavity. Conclusion The short-term results of endovascular stent-graft treatment are satisfied, but long-term outcomes needs to be further observed.