腹主动脉瘤腔内隔绝术相关器械及其应用技术

Equipment and the Techniques in the Procedure of Endovascular Exclusion for Abdominal Aortic Aneurysm

目的 探讨腹主动脉瘤 (AAA)腔内隔绝术 (EVE)相关器械的应用技术。方法 对 85例肾下腹主动脉瘤患者进行了腔内隔绝术 ,主要采用主体 单肢嵌接式移植物 ,相关器械主要有DSA及附属设备 ,各种造影导管、多用途导管、导丝、圈套器、球囊等。采用双侧腹股沟下方纵切口 ,经股总动脉将输送器导入预定位置 ,释放移植物 ,在瘤腔内将移植物单肢与主体连接形成分叉型新的血流通道 ,将动脉瘤隔绝。根据术中不同情况采用上述介入器械。结果 采用球囊导管扩张 8例 ,加用裸支架 3例 ,钢圈栓塞右侧髂内动脉 6例 ,应用鹅颈圈套器将导丝从主体侧牵入接口侧股动脉 3例 ,使用多用途导管帮助导丝跨越移植物分叉 5例 ,在接口侧帮助导丝定向 3例。结论 EVE对设备及导管技术操作要求非常高 。

Purpose To discuss the usage of equipment and techniques for the procedure of abdominal aortic aneurysms treated by endovascular exclusion. Methods Eighty five patients with infra renal abdominal aortic aneurysms received endovascular stent graft exclusions. The stent garfts used were body to limb combined styles. The interrelated instruments were the fluoroscopic equipment, series of angiographic catheters, multi usable catheters, guide wires, snares, balloons, etc. After the longitudinal incisions inferior to both sides of the groin, the common femoral arteries were exposed, and the delivery systems were inserted to the target region. After the deployment of the stent grafts, the limb was connected with the mainbody, and a bifurcated graft that made the new blood canal excluded the aneurysm sac with the blood flow. The equipment above was used to fit the needs of different conditions in the procedure. Results Eight cases received the ballooning. Three cases needed the bare stents for limb restriction. Coiling of the right internal iliac artery was needed in six cases. Goose neck snares were used in three cases to retreat the wire into the bilateral femoral artery. Multi usable catheters were used in five cases to assist the wire crossing the bifurcation of the stent grafts, and in three to locate the wire to penetrate into the connecting segment. Conclusion Endovascular stent graft exclusion needs high skills of catheter techniques. Abundant of convenient intervention equipment is significantly helpful for the success of the procedure.