主动脉腔内修复术后中远期并发症与二次处理策略

Mid-long term complications of endovascular repair in aortic diseases and its secondary interventional strategies

目的探讨主动脉腔内修复术后中远期并发症的处理方法与效果。方法 1999年5月至2007年6月对21例主动脉病变腔内修复术后中远期并发症进行了再次处理。其中腹主动脉瘤(AAA)15例,胸主动脉动脉瘤(TAA)3例,主动脉夹层(TAD)3例。并发症:Ⅰ型内漏11例,Ⅱ型内漏4例,Ⅲ型内漏2例;移植物阻塞4例。应用延长支架型血管技术处理Ⅰ、Ⅲ型内漏(6例),应用"侧孔"、"凹口"、"分叉"支架型血管结合颈部血管旁路手术重建主动脉弓处理Ⅰ型内漏(3例),应用栓塞技术处理Ⅱ型内漏(4例),应用取栓和旁路手术技术处理移植物阻塞(4例),应用开放手术技术处理动脉瘤破裂(1例)。结果 20例(95.2%)应用腔内技术作为二次处理主要手段,二次处理30d内死亡1例(4.7%),因技术需要而修改器材结构者3例。二次术后仍存在内漏者5例(29.4%,5/17)。二次干预瘤体相关性死亡3例(14.3%)。结论内漏和移植物阻塞是腔内修复术后主要中远期并发症,其主要原因是原发性内漏的延续和移植物移位。腔内技术可作为二次处理的主要手段。主动脉弓部病变进行二次干预有更大的挑战性。

Objective To investigate the methods and effects of secondary intervention for mid-long term complications of endovascular repair（EVR） in aortic diseases. Methods From May 1999 to Jun 2007, 21 patients with mid-long term complications after EVR were treated in our center. Of these cases, 15 cases received first EVR for abdominal aortic aneurysm （ AAA）, 3 cases for thoracic aortic aneurysm （TAA） and 3 cases for aortic dissection （TAD）. The mid-long term complications included 11 cases of type Ⅰ endoleak, 4 cases of type Ⅱ endoleak, 2 cases of type Ⅲ endoleak and 4 cases of migration of stent grafts. Proximal or distal extensions were used for type Ⅰ and Ⅲ endoleak in 9 cases. Fenestrated, scallop and bifurcated stent grafts were used to reconstruct the aortic arch in 3 cases. Emboli technique was used in treating type Ⅱ endoleak. Thrombectomy and bypass technique were used in 4 cases with stent graft limb occlusion. One ruptured AAA accepted open surgery. Results Secondary endovascular technique were undergone in 20 （95.2%） cases. One case died in 30 days after the secondary intervention and endoleak remained after the secondary operation in 5 cases. Three cases died of the secondary intervention. Conclusions Endoleak and limb occlusion were the chief mid-long complications after EVR. Secondary endovascular technique can be used in most cases and carries great challenges in aortic arch lesions.