经股动脉带膜支架腔内搭桥治疗动脉瘤的初步应用

Endoluminal stent graft repair of aortic aneurysms

目的 探讨带膜支架腔内治疗动脉瘤的临床意义。 方法 应用进口及自制带膜支架 ,在透视下经股动脉放置在动脉瘤的恰当位置上 ,实现动脉瘤的腔内搭桥。 结果 4例胸主动脉瘤 ,1例累及肾动脉、肠系膜上动脉及腹腔动脉的腹主动脉瘤及 1例髂动脉瘤应用直筒状带膜支架 ;5例肾动脉下腹主动脉瘤应用分叉状带膜支架腔内治疗 ,即刻效果满意。随访 3～ 19个月 ,定期CT及MRA检查。 5例术后 5～ 8d出现延迟性发热。 1例术后 3个月发现有少量漏血。 1例术后出现脑梗塞致轻度偏瘫。 结论 动脉瘤的腔内治疗具有创伤小、技术操作可行、效果肯定的优点。它可以作为动脉瘤治疗的另一有效手段 ,尤其适合不能耐受传统手术的高危患者 ,但远期效果有待临床进一步观察。

Objective To study the clinical value of the treatment of aortic aneurysms with endovascular stent graft prosthesis. Methods After a unilateral surgical arteriotomy, Talent, Vanguard and Chinese stent graft were advanced through the femoral arteries and placed in the proper position of the aneurysm sac under X ray fluoroscopic guidance. Results Four patients with descending aneurysm, 1 patient with abdominal aortic aneurysm(AAA) involving the renal artery, superior mesenteric artery and celiac artery, and 1 patient with right common iliac artery aneurysm received straight stent grafts. Five patients with infrarenal AAA received bifurcated stent grafts. CT and MRA were performed during a follow up of 3 19 months. Aortic aneurysms were completely excluded from the circulation. Five patients prolonged fever was noted and 1 patient was found to have a leakage 3 months later, and hemiplegia in 1 after procedure. Conclusions Endovascular treatment of aortic aneurysm is technically feasible and can effectively exclude aortic aneurysms from the circulation. Endoluminal repair may serve as an interventional strategy to treat aneurysm, especially in patients at high surgical risk, but long term effect needs further study.