腹主动脉瘤腔内修复术中特殊近端锚定区的处理

The treatments of hostile proximal landing zone of abdominal aortic aneurysm in endovascular aneurysm repair

目的探讨腹主动脉瘤腔内修复术(EVAR)中特殊近端锚定区的处理方法。方法1997年7月至2005年7月对41例特殊类型腹主动脉瘤(瘤颈过短、严重成角、严重钙化、附壁血栓、形态不规则等)的腔内修复术中,根据情况分别采用近端裸支架跨肾动脉技术、覆盖部分肾动脉并肾动脉支架成形技术、针对成角选择合理产品、近端裸支架内支撑技术、近端延长支架型血管内支撑技术、“凹口”状支架型血管保留肾动脉技术来处理特殊近端锚定区的病变。结果41例EVAR中原发性近端Ⅰ型内漏发生率17·1%(7/41),随诊发现原发性内漏4例自愈,3例转化为持续性内漏,另发现4例继发性内漏。术后30d近端Ⅰ型内漏发生率17·1%(7/41)。无中转开腹手术及术中瘤体破裂、肾梗死等情况发生。结论对特殊近端锚定区的病例,通过相关技术处理可以使之适合腔内治疗。

Objective To probe the treatments of hostile proximal landing zone of abdominal aortic aneurysm（AAA） in endovascular aneurysm repair（EVAR）. Methods 41 AAA cases which include excess short proximal neck,severe angulation,severe calcification,mural thrombosis,irregular neck shape were treated by the following methods and techniques： anchoring the proximal bare stent above the renal arteries,covering a part of lowest renal artery and then angioplasty and stent of the renal artery, placing the joint of connecting segment of stent-graft in the site of angulation,selecting a reasonable stent-graft to fit the angulation, using great diametric bare stent and proximal cuff in stent-graft,et al. Results Prima ry proximal type Ⅰ endoleak incidence rate was 17.1% （7/41）at the end of EVAR in 41 eases. 4 of 7 primary proximal type Ⅰ endoleaks cases sealed during follow-up and the other 3 cases translated to durative type Ⅰ endoleak. 4 secondary type Ⅰ endoleak were detected during follow-up. Advanced stage proximal type Ⅰ endoleak rate was 17. 1% （7/41）in these 41 cases. No conversion to open operation, renal infarction, rupture and other complications. Conclusion Hostile proxi- mal landing zone of AAA can be treated satisfactorily by some special technique which make it suit for EVAR. With the development of technique and device,the indications of EVAR for AAA will be wided.