腔内隔绝术治疗肾下型腹主动脉瘤24例疗效分析

Efficacy analysis of endovascular graft exclusion for the treatment of 24 patients with infra-kidney abdominal aortic aneurysms

目的 探讨腔内隔绝术治疗肾下型腹主动脉瘤的疗效、适应证及其并发症的防治.方法 回顾性分析2006年4月至2008年9月经CT血管造影或磁共振血管造影确诊为肾下型腹主动脉瘤24例患者的临床资料.切开双侧股动脉,经股动脉将覆膜支架置于肾动脉下方,支架自膨张开,使血流经人造血管流向髂总动脉.结果 支架植入全部成功,术后即刻造影20例无内漏,4例存在轻度Ⅰ型内漏.无支架移位,无脏器及双下肢缺血表现.术后6个月复查CT增强扫描示全部病例支架形态完好,动脉瘤消失,支架外血栓形成.结论 腔内隔绝术治疗腹主动脉瘤具有简捷、微创、并发症少、术后恢复快等优点,为老年患者治疗肾下型腹主动脉瘤的首选方法.

Objective To investigate the efficacy and the indication and the management of perioperative complications in treatment of infra- kidney abdominal aortic aneurysm （AAA） by using endovascular graft exclusion （EVGE）. Methods From April 2006 to September 2008, 24 patients with infra- kidney abdominal aortic aneurysms were diagnosed by contrast-enhanced CT or MRI scan. Vascular access was obtained through the bilateral femoral artery after arteriotomy and stent-graft was deployed into AAA of below the renal artery to occlude the left over cavity of AAA. The stent- graft was extended and anchored to the both side wall of AAA, the blood flow enter into the arteria iliaca communis through the sten＇t.Results Stent-graft deployment was successfully performed in all the patients. Immediate aortography after the procedure showed no leakage in 20 patients and the type Ⅰ minor leakage in 4 patients. No stent movement or organ and both lower extremities ischemia was found at the early post operative stage in all the patients. Six months after the operation, in all the 24 patients, contrast-enhanced CT scan showed the disappearance of the aneurysm and thrombosis at the level of the stent. Conclusions EVGE is simple,minimally invasive,less complication and quick recovery after operation. Thus it becomes first choice for the treatment of AAA for the elder patients.