一体式分叉型覆膜支架在腹主动脉及髂动脉病变腔内治疗中的应用

Endovascular repair of abdominal aortic disease with unibody bifurcated stent grafts

目的探讨一体式分叉型覆膜支架治疗腹主动脉及髂动脉病变的疗效。方法本组3l例患者应用一体式分叉型覆膜支架治疗，男26例，女5例；年龄38—84岁，平均（64．5±10．7）岁。腹主动脉真性动脉瘤17例，腹主动脉穿通溃疡5例，髂动脉瘤4例（双侧受累2例），腹主动脉假性动脉瘤2例，腹主动脉瘤EVAR术后远端漏2例，腹主动脉夹层1例。使用MicroportAegis（上海微创）支架22例，Powerlink（ENDOLOGIX公司）支架9例。术后1、3、6、12个月及以后每年一次行检查随访。结果31例均成功置入支架，手术成功率100％。覆膜支架主体近端直径20～28mm，主体支架长度120～140mm；封闭一侧髂内动脉13例，双侧髂内动脉均保留15例。随访3～36个月，支架内血流通畅，无内漏及支架移位发生。结论一体式分叉型覆膜支架治疗肾下腹主动脉病变及髂动脉病变近中期疗效满意，远期疗效尚需长期随访。

Objective To explore the efficiency of endovascular treatment of abdominal aortic and/or iliac artery disease with unibody bifurcated stent grafts. Methods Thirty-one patients, including 26 male and 5 female, average age （64.5± 10.7 ）years old, ranging from 38 to 84 years old, who underwent endovascular abdominal aortic repair because of abdominal aortic and/or iliac artery disease were enrolled. Pathologies included true abdominal aortic aneurysm in 17 cases, abdominal penetrating aortic ulcer in 5 cases, iliac artery aneurysm in 4 cases with bilateral involved in 2 cases, pseudoaneurysm in 2 ca- ses, distal stent-graft endoleak after EVAR in 2 cases and abdominal aortic dissection in 1 case. MicroPort Aegis stent-grafts were implanted in 22 cases and Powerlink endologix stent-grafts were implanted in 9 cases. Follow-up imaging consisted of con- trast-enhanced CT scans at 1, 3, 6, 12 months, and annually thereafter. Results Technical success was achieved in all pa- tients. The diameter of the main body ranged from 20 mm to 28 mm and the length ranged from 120 mm to 140 ram. Unilateral iliac artery was excluded in 13 cases and bilateral iliac arteries were kept in 15 cases. After follow-up 3-36 months, all lesions were excluded successfully with patent stent-grafts, with no endoleak or other complications occurred. Conclusion Endovas- cular abdominal aortic repair with unibody bifurcated stent grafts demonstrated satisfactory short-term and mid-term result, long- term follow-up is necessary.