腹主动脉瘤腔内修复术的治疗体会

Experience of endovascular aortic aneurysm repair

目的总结腹主动脉瘤腔内修复术(EVAR)的围手术期临床经验。方法回顾分析2005年~2012年在我科行EVAR术的89例患者的临床资料。术前CT血管造影(CTA)检查相关参数并对主要脏器进行评估,选择合适的覆膜支架和手术方式。在支架释放前准确定位最低肾动脉位置,至少保留一侧髂内动脉通畅,若双侧需要覆盖,分期覆盖或髂内动脉重建。结果术后急性肾功能衰竭死亡1例(1.1%)。支架近、远端Ⅰ型内漏各4例及1例,Ⅲ型内漏3例,均进行相应处理,内漏消失。单侧髂肢闭塞并继发血栓形成3例,Fogarty导管取栓并支架植入;腹壁切口裂开1例,清创缝合。患者随访6个月至5年,死亡2例,其中1例死于恶性肿瘤,1例死于慢性肾功能衰竭。结论术前评估是EVAR治疗取得成功的首要因素。EVAR是高危、高龄腹主动脉瘤患者安全有效的治疗方法,但需要长期严格随访并及时处理并发症。

Objective To summarize the perioperative experience of endovascular aortic aneurysm repair (EVAR). Methods The clinical data of 89 cases with abdominal aortic aneurysm (AAA),who underwent EVAR between 2005 and 2012, were analyzed retrospectively. Parameters were examined by computed tomographic angiography (CTA), and major organs were evaluated before operation in order to select suitable stent-graft and operation methods. The lowest renal artery must be accurately oriented before deployment of stent-graft and at least unilateral internal iliac artery should be reserved. If bilateral internal iliac artery must be covered, staged coverage or internal iliac artery reconstruction should be considered. Results After operation, 1 patient died of acute renal failure (1.1%). Proximal and distal typeⅠendoleak,and typeⅢendoleak occurred in 4, 1 and 3 cases, respectively,and the endoleaks disappeared after proper treatment. Three cases developed unilateral iliac limb occlusion combined with thrombosis, and underwent fogarty catheter embolectomy and stent implantation. Debridement and suturing were performed in 1 case with abdominal incisional rupture. All patients were followed-up for 6 months to 5 years. During the period, 2 cases died, including 1 malignant tumor and 1 chronic renal failure. Conclusion Preoperative evaluation is the most important factor for success of EVAR treatment. EVAR is a safe and efficient procedure for high-risk and aged patients with AAA. Long-term strict follow-up and immediate management of complications are necessary.