降主动脉假性动脉瘤腔内治疗临床分析

Endovascular repair of descending aortic pseudoaneurysms

目的分析评价降主动脉假性动脉瘤腔内修复（EVAR）的可行性、疗效和结果。方法回顾性分析2007年4月到2010年11月20例降主动脉假性动脉瘤患者的临床资料。其中男性18例，女性2例；年龄28～82岁，平均（58±16）岁。20例中贝赫切特综合征4例，确诊感染性假性动脉瘤6例，疑诊感染性假性动脉瘤5例，医源性损伤1例，合并慢性粒一单核细胞白血病1例，原因不明3例。假性动脉瘤分布部位以腹主动脉多见（88．5％）。20例中EVAR15例，开放手术2例，未手术治疗3例。回顾性分析15例EVAR患者的治疗情况及随访结果。结果15例降主动脉假性动脉瘤EVAR技术成功率15／15，共放置腹主动脉分又型覆膜支架6个，腹主动脉直筒型覆膜支架6个，胸主动脉直筒型覆膜支架2个和肾上腹主动脉裸支架1个。1例采用了裸支架支撑下弹簧栓栓塞术。围手术期病死率为0，除2例原发性Ⅳ型内漏外，无原发性I型内漏发生。14例获得随访，随访率14／15，平均随访时间538d，随访期间总病死率4／14，动脉瘤相关事件发生率6／14，二次手术率1／14，无动脉瘤相关事件存活率8／14。结论对降主动脉假性动脉瘤行EVAR，具备一定的技术可行性，其技术成功率高，围手术期间病死率低，但随访期间动脉瘤复发、增大、破裂以致死亡的风险较大。病因治疗、严密随访可能有助于改善主动脉假性动脉瘤EVAR的预后。

Objective To evaluated the feasibility, efficacy, and outcome of endovascular repair for descending aortic pseudoaneurysms. Methods From April 2007 to November 2010, 20 patients of descending aortic pseudoaneurysm were treated. There were 18 male and 2 female, aged from 28 to 82 years with a mean of （58 ± 16） years. In this group, 4 patients were diagnosed as Behqet＇s syndrome, 6 patients as mycotic pseudoaneurysms with positive blood culture, 6 patients as suspected mycotic pseudoaneurysms, 1 patient with iatrogenic pseudoaneurysm and 1 patient with chronic grain-mononuclear cell leukemia, the other 3 patients with unknown reasons. The 88. 5% of aortic pseudoaneurysms were located at abdominal aorta. Fifteen patients underwent endovascular therapy and 2 patients were treated by traditional open surgery. The other 3 patients underwent conservative treatments. The data of treatments and follow-up in the 15 patients who received endovascular repairs were retrospectively analyzed. Results Endovascular therapy was performed successfully on the 15 patients, and the technique successful rate was 15/15. Total 15 stentts were transluminal placed including 6 bifurcate stent-grafts, 6 abdominal straight stent-grafts, 2 thoracic straight stent-grafts and 1 abdominal bare stent. One patient was treated by stent assisted embolization. Perioperative mortality rate was 0. Only 2 primary type IV endoleaks were found. Fourteen patients were successfully followed up. During a mean follow-up of 538 days, 8 （57. 1% ） patients were uneventful Six （42. 9% ） patients were complicated by aneurysm related events, including 4 （ 28. 6% ） aneurysm-related deaths, 1 （7. 14% ） with delayed endoleak and 1 （7. 14% ） with recurrent pseudoaneurysm which was retreated by another stent-graft. Conclusions Endovascular therapy for descending aortic pseudoaneurysms is a feasible and mini-invasive option with high technique success rate and low perioperative mortality rate. However, risk of recurrence and rupture to death of pseudoaneurysm remains high during follow-up. Treating the underlying reasons and intensively follow-up may be good pseudoaneurysms treated by endovascular therapy.