腹主动脉瘤腔内修复术中特殊远端锚定区的处理经验

The clinical experience for the management of distal landing zones in patients of abdominal aortic aneurysm undergoing endovascular repair

目的探讨腹主动脉瘤腔内修复术中特殊远端锚定区的处理方法以及并发症。方法自1997年5月至2006年12月在150例包括髂总动脉瘤、髂内动脉瘤、髂动脉狭窄、严重成角等特殊远端锚定区的腹主动脉瘤腔内修复术中,根据情况选择不同的处理方式,术后观察内漏、缺血并发症、髂动脉瘤形态以及旁路血管的通畅性。结果围手术期死亡率4％（6／150）,总死亡率42．5％（51／120）。6例原发性远端I型内漏,5例自愈,1例转化为持续性内漏;3例髂内动脉返流引起的Ⅱ型内漏随访中均自愈。7例单臂支架型血管,股股旁路手术2年通畅率为86％;4例髂内动脉旁路手术2年通畅率为100％。11例栓塞单侧髂内动脉出现臀肌缺血症状,平均症状消失时间42 d（5-90 d）。结论结合传统外科技术以及腔内技术,并选择合适的产品处理腹主动脉瘤特殊远端锚定区可取得满意疗效。中远期结果仍需观察。

Objective To probe the management of hostile distal landing zones of abdominal aortic aneurysm （AAA） in a process of endovascular aneurysm repair （EVAR）. Methods From May 1997 to Dec 2006, 150 AAA cases including common iliac artery （CIA） aneurysm, internal iliac artery （IIA） aneurysm, iliac artery stenosis, severe angulation were treated by different strategies based on varied configuration of distal landing zones. The changes of aneurysms, endoleak, ischemia complications, and the patency rate of bypasses were evaluated after operations. Results Perioperative mortality was 4% （6/150）, and overall mortality was 42. 5% （51/120）. Primary distal type Ⅰ endoleak in 6 cases, underwent self-healing in 5 cases and transformed to permanent endoleak in one case. Three cases of primary type Ⅱ endoleak for internal iliac artery were self-healed. Seven underwent EVAR with aortouniiliac （AUI） endovascular stent-graft with cumulated 2-year patency for femorofemoral bypass of 86%. The 2 year patency rate was 100% of internal iliac bypass in 4 cases. Eleven cases suffered from transient buttock ischemia after unilateral intrainternal iliac artery embolization. Conclusions Combination traditional surgeries and endovascular therapy and properly selected materials and stent-grafts is conducive to a satisfactory management of hostile distal landing zones in cases of AAA, though the mid-term and long-term results remain to be identified.