腹主动脉瘤腔内修复术中特殊远端锚定区的处理策略

The treatment strategy of special distal landing zones in endovascular repair of abdominal aortic aneurysm

目的探讨对腹主动脉瘤腔内修复术（EVAR）中特殊远端锚定区的评估及处理方法。方法回顾性分析2007年1月至2010年12月应用EVAR治疗的66例复杂远端锚定区腹主动脉瘤患者的临床资料。其中男性45例，女性21例，年龄53—87岁，平均62岁。本组Ⅰ型及ⅡA型病例共20例，其中髂总或髂外动脉〉50％狭窄10例，髂总或髂外动脉严重扭曲者6例，合并以上情况者4例；双髂总合并髂内动脉瘤46例（单侧32例，双侧14例）。支架血管移植物采用Medtronic46例，COOK14例，Microport4例，Lifetech2例。结果平均手术时间90min，术中移植物明显短缩22例（33．3％），Ⅱ型内漏18例（18／66，27．3％），Ⅲ型内漏5例（7．6％），髂支〉50％的狭窄2例（3．0％），同时合并Ⅱ、Ⅲ型内漏5例（7．6％），同时合并髂支狭窄及Ⅲ型内漏4例（6．1％）。本组随访时间3～36个月，平均22个月，随访期间内移植物向远端移位2例（3．0％），移位均〈10mm，髂支再狭窄（〉50％）2例，Ⅱ型内漏自行消失18例（18／23，78．3％），Ⅲ型内漏0例；死亡2例。结论复杂远端锚定区增加了EVAR并发症发生率。熟悉移植物特性，合理应用处理策略，可提高EVAR技术成功率。

Objective To study the assessment and management for abdominal aortic aneurysm （AAA）＇s special distal landing zones in endovascular repair （EVAR）. Methods The clinic data of 66 AAA patients with complicated distal landing zones From January 2007 to December 2010 was retrospectively analyzed. There were 45 male and 21 female patients, aged from 53 to 87 years with a mean of 62 years. All patients underwent the CT angiography examination （1 to 2 mm interval） to obtain the necessary anatomical data. In this group, there were 20 cases with type Ⅰ and Ⅱ A lesions, including 10 cases with narrow common iliac arteries/external iliac arteries （ 〉 50% ）, 6 cases with seriously distorted common lilac arteries/external iliac arteries, 4 cases with the characters of the above, 16 cases with bilateral common iliac aneurysms, 46 cases with bilateral common iliac aneurysms combined internal iliac aneurysms （ unilateral 32 cases, bilateral 14 cases）. The vascular stent-grafts＇ usage was as follow： Metronic 46 cases, COOK 14 cases, Microport 4 cases, Lifetech 2 cases. Results The mean operative time was 90 min. There were significant stent-graft shortening in 22 cases （33.3%）, type Ⅱ endoleak in 18 cases （27.3%）, type Ⅲ endoleak in 5 cases （7.6%）, iliac stents＇ stenosis （ 〉50% ） in 2 cases （3.0%）, type Ⅱ combined with type Ⅲ endoleak in 5 cases （7. 6% ）, iliac stents＇ stenosis combined with type m endoleak in 4 cases （6. 1% ）. Patients were followed for a mean of 22 months （range from 3 to 36 months）, during the time of follow-up, the following conditions were observed： stent-graft displacement （to the remote 〈 10 mm） in 2 cases （3.0%）, illiac stents restenosis （ 〉50% ） 2 cases, type Ⅱ endoleak healed in 18 cases （18/23, 78.3% ）, and no type Ⅲ endoleak remained. The fatality rate was 3.0% （2/66）. Conclusions Special distal landing zones increased the operative complication rate in EVAR. Being familiar with the features of stent-graft and appropriate use of various surgical management can increase the success ratio of EVAR.