腔内隔绝术治疗胸腹主动脉瘤的临床应用

Clinical study on endovascular graft exclusion as a treatment of thoracoabdominal aortic aneurysm

目的探讨腔内隔绝术治疗胸腹主动脉瘤的疗效和安全性。方法2000年5月～2004年10月,采用腔内隔绝术治疗胸腹主动脉瘤7例,其中4例胸主动脉夹层动脉瘤、1例胸主动脉假性动脉瘤、2例肾下型腹主动脉瘤,术后随访采用彩超和增强CT检查。结果7例病人共成功置入10个支架。随访2～28个月,所有支架位置、形态正常。4例胸主动脉夹层动脉瘤的内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成。1例胸主动脉假性动脉瘤和2例肾下型腹主动脉瘤的瘤体缩小。2例术后出现微小内漏,分别在2个月、6个月后内漏自行封闭,1例术后出现髂外动脉夹层经PTA和Wallstent治疗。结论腔内隔绝术能有效治疗胸腹主动脉瘤,具有创伤小、疗效确切和并发症少等优点。

Objective To evaluate the clinical outcome and safeness of endovascular graft exclusion as a treatment of thoracoabdominal aortic aneurysm. Methods From May 2000 to October 2004, 7 patients with thoracoabdominal aortic aneurysm, including 4 cases of Debakey III thoracic aortic dissection, 1 of false thoracic aortic aneurysm and 2 of abdominal aortic aneurysm, were treated by endovascular graft exclusion. Immediate post-interventional aortography was performed and color Doppler ultrosonography and contrast enhanced CT scan were done during the follow- up study. Results All 7 procedures, in which 10 stent-grafts were placed, were technically and clinically successful. During the 2-28 month follow-up, the serial follow-up imaging demonstrated that the locations and shapes of the stent-graft were stable in all patients; the entry tears were occluded; and the tree lumens of thoracic and abdominal aorta were enlarged; thrombosis in the false lumens was exhibited as well. Follow-up CT revealed the sizes of the false aneurysm decreased and thrombi formation within the lumen in 1 case of thoracic aortic false aneurysm. In 2 cases of abdominal aortic aneurysm below renal artery, the aneurysm was decreased in size after the intervention. Slight endoleakage occurred in 2 cases, which automatically ceased in 2 to 0 months after the procedure. In 1 case of arterial, the extra dissection of iliac artery was eventually corrected by PTA and Wallstent placement. Conclusion Endovascular graft exclusion is an effective and safe treatment of thoracoabdominal aortic aneurysm.