腹主动脉瘤腔内修复术中不良近端锚定区对内漏的影响

The influence of hostile neck anatomy on endoleaks after endovascular aneurysm repair

目的探讨肾下腹主动脉瘤腔内修复术中不良近端锚定区（hostile neck anatomy，HNA）对Ⅰa型内漏的影响。方法2008年7月至2011年7月对195例非破裂肾下腹主动脉瘤患者行腔内修复术治疗。其中男150例，女45例。年龄52～95岁，平均（69．0±2．5）岁。43例为HNA（22．1％）。所有患者术前均进行CT血管重建检查，获得瘤颈的相关资料，统计分析HNA与Ⅰa型内漏的关系。术后3、6、12个月及每年进行随访。结果195例术中23例出现Ⅰa型内漏，采用反复球囊扩张、延长型支架、Palmaz支架及烟囱技术进行治疗，仅1例术后仍残留少量内漏。技术成功率为98．5％（192／195）。其中瘤颈成角与Ⅰa型内漏的发生明确相关。平均随访时间（18±3）个月，1年生存率为97．4％（190／195），3年生存率为89．2％（174／195）。结论近端锚定区成角与Ⅰa型内漏相关，术中Ⅰa型内漏修复成功率高，中远期结果满意。

Objective To determine the influence of hostile neck anatomy on type Ⅰa endoleak development after endovascular aortic aneurysm repair （EVAR） for infrarenal abdominal aortic aneurysmal disease. Methods From July 2008 to July 2011, 195 consecutive patients with non-ruptured abdominal aortic aneurysms （AAA） were treated with EVAR. There were 150 males and 45 females, aging from 52 to 95 years with a mean of 69 years. Forty-three patients were with hostile neck anatomy （ HNA ）. High- resolution computed tomography was abtained in all patients, with detailed measurement of proximal neck parameters. Univariate and multivariate analyses were used to compare Ⅰa endoleak and HNA. Follow-up protocol consisted of computed tomography （CT） angiograms or ultrasound at 3, 6, and 12 months, and annually thereafter. Results Twenty-three patients had intraoperative type Ⅰa endoleaks. The adjunctive measures, such as repeated balloon angioplasty, cuff extension, Palmaz stent placement and chimney technique were used for treating type Ⅰa endoleak. Small endoleak remained in only one patient. The technical success rate was 98. 5% （192/195）. The association between type Ⅰ a endoleak development and magnitude of the infrarenal angle was statistically significant. The mean follow-up time was （ 18 ± 3 ） months. The survival rates at 1- and 3-year were 97.4% and 89.2% respectively. Conclusions The proximal neck angle is related to intraoperative type Ⅰa endoleak occurrence, but other factors often thought to be indicative of adverse neck anatomy are not significant predictors. Most typeⅠa endoleaks in this study were successfully eliminated intraoperatively with a satisfactory mid to long term results.