肾下型腹主动脉瘤腔内修复治疗的并发症分析

Study on the complications of endovascular repair for infrarenal abdominal aortic aneurysm

目的：总结腔内修复治疗腹主动脉瘤的经验，探讨并发症的及防治策略。方法：回顾分析及随访已接受腔内修复治疗的43例肾下型腹主动脉瘤患者的临床资料，分析腔内修复手术并发症的病因和防治。结果：本组发生了内漏、支架移位、移植物综合征、手术入路损伤等支架相关并发症。最常见的是内漏，发生原发性内漏11例，Ⅰ型8例，Ⅱ型1例，Ⅲ型2例。Ⅱ型内漏术中未处理，Ⅰ、Ⅲ型内漏经过球囊扩张、植入支架型血管或裸支架等处理后仍残留2例J型内漏。4例手术入路损伤经内膜剥脱治愈。随访发现迟发性内漏4例，继续随访1～2年，未见瘤体明显增大；手术结束时残留的3例原发性内漏自愈，但其中1例出现内漏复发及支架移位，导致动脉瘤复发破裂而再次接受腔内治疗。结论：支架相关并发症与动脉瘤血管解剖条件、移植物缺陷和操作技术有关，其防治需要良好把握手术适应证、合理选择支架及成熟的操作经验。

Objective： To investigate prevention and treatment of complications by summariz- ing our experience of endovascular aneurysm repair. Methods： By analyzing retrospectively the clinical data of 43 cases of infrarenal abdominal aortic aneurysm treated by endovascular repair （E- VAR）, prevention and treatment of complications were investigated. Results： There were compli- cations related to stent in this team, such as endoleak, graft migration, postgraft syndrome and injury of the access arteries. The endoleak was the most common complication. Of eleven cases with the primary endoleak at stent-graft deployment, eight cases developed type I endoleak, one developed type II , and two developed type lU . Type II endoleak was untreated. Type I and III endoleaks were treated via balloon dilatation or endoluminal graft implantation while two cases of type I en- doleak remained. Four cases with injury of the access arteries were cured with endarterectomy. During follow-up, the secondary endoleak occured in four cases, which caused little size variation of the aneurysm during continued follow-up for 1 to 2 years. Three residual primary endoleaks disap- peared, but one case developed recurrent endoleak and graft migration which ted to recurrence of the aneurysm and rupture and a endovascular repair again. Conclusions： Complications related to stent are associated with anatomic condition, stent defects and surgical skill. Prevention and treat- ment of complications need a good grasp of surgical indications, reasonable choice of stent, and mature operating experience.