腔内隔绝术治疗腹主动脉瘤

Endovascular exclusion of abdominal aortic aneurysm

目的探讨腹主动脉瘤（ＡＡＡ）腔内隔绝术的手术指征、手术方法、操作要点和存在的问题。方法１例高龄男性和多病并存的ＡＡＡ患者在全麻和选择性动脉造影动态监控下，用１１．０ｃｍ×２．６ｃｍ的内支撑－涤纶血管复合体，对ＡＡＡ进行了腔内隔绝术。结果术后１周和２０天分别行彩超和螺旋ＣＴ复查显示：复合体内径为２．２～２．４ｃｍ，通畅，无移位和扭曲。复合体壁外原ＡＡＡ腔内充满血栓，未探及通畅的腰动脉和肠系膜下动脉，ＡＡＡ外径无变化。复合体近端与ＡＡＡ颈前壁之间有一微裂隙，但对ＡＡＡ体影响不大。随访６个月，患者腹部搏动性肿块及左下肢间歇性跛行消失。结论ＡＡＡ腔内隔绝术避免了传统ＡＡＡ手术的各种缺点，而具简便、微创和疗效确实的优点，有良好的应用价值。

Objective To explore the indications,methods,manipulations, and problems of endovascular exclusion of abdominal aortic aneurysm(AAA). Method Under general anesthesia and dynamic supervision of DSA,an endovascular exclusion with a stent graft complex of 11 0 cm×2 6 cm was successfully performed on a 70 year old man contraindicated for major open surgery with AAA of 10 0 cm×6 0 cm and an AAA neck of 2 5 cm×1 6 cm. Result The patient was up and about on the first postoperative day.Duplex scan(by the end of the first postoperative week) and CT(on the postoperative 20th day) revealed a completely excluded AAA by the stent graft that was patent and had an inner diameter of 2 2～2 4 cm,without migration and torsion. The primary AAA sac was full of thrombi and no patent lumbar and inferior mesenteric arteries were observed. The external diameter of AAA was unchanged,renal and iliac arteries were all patent,but a microcrevice between the proximal end of the stent graft and the anterior wall of the AAA neck was revealed.Six months postoperative follow up showed that the patient′s abdominal pulsatile mass and the left lower extremity′s claudication disappeared. Conclusion Endovascular exclusion of AAA is of great practical value.