近肾动脉腹主动脉瘤腔内搭桥治疗的实验研究

The experience study of transrenal artery oral endoluminal stent graft bypass of abdominal aortic aneurysms

目的 :研制可跨过肾动脉开口的国产带膜支架并检验其腔内治疗近肾动脉腹主动脉瘤的可行性。方法 :以镍钛记忆合金 ( nitinol)及国产人造血管为材料制作上端裸露的带膜支架 ,通过输送器在透视下将支架放置在动脉瘤模型的恰当位置 ,裸露部分跨过肾动脉 ,使动脉瘤完全得到旷置。随访 1～ 12月观察支架放置后病理变化。结果 :7例近肾动脉腹主动脉瘤 5例治疗效果满意 ;1例支架放置过高致一侧肾动脉阻塞 ;1例支架放置过低支架上端发生漏血。尸检 :5例支架上端裸露部分均跨过肾动脉 ,其中 3例支架合金丝跨过肾动脉开口未引起肾动脉栓塞。 1例支架膜部覆盖左肾动脉开口 ,左肾萎缩 ,1例瘤体近端发生漏血。结论 :术中经颈动脉插管造影观察支架放置状况更有利于精确定位 ;较小直径的记忆合金线跨过肾动脉不引起该动脉堵塞 ,但远期结果有待进一步探讨 ;

Objective:To research and manufacture the Chinese stent graft stuited for transrenal artery oral and its′ feasibility of endovascular repair for abdominal aortic aneurysm (AAA). Methods:To make the upper bare spring stent graft by Nitinol and silk manufacturing vascular, place the stent graft in the proper position of aneurysm under X ray fluoroscopic with the bare spring covered the renal artery oral and observe the pathologic changes after procedure 1 to 12 months. Results:5 of 7 close infrarenal AAA were effectively excluded aneurysm from the blood circulation and 3 cases bare spring cross the renal artery oral without the artery thrombosis. 1 case with left renal artery occlusion because of the too high placement and 1 case with the endoleak from proximal conjunction caused by incompletely repair. Conclusion:The angiography via common carotid artery puncture is a more exactly method to define the position of stent graft during operation. The 0 02 mm Nitinol spring don′t lead to renal artery occlusion. It is possible to use the stent graft made by ourself in the clinical patient with close infrarenal AAA in future.