主体-单肢对接式移植物治疗腹主动脉瘤关键技术探讨

Essential techniques in the endovascular exclusion for abdominal aortic aneurysms using bifurcated limb-connect-to-mainbody stent-grafts.

目的 讨论腹主动脉瘤 (AAA)腔内隔绝术 (EVE)中主体 -单肢对接式移植物的应用经验及术中问题的解决方法。方法 87例肾动脉水平下AAA的EVE中采用了主体 -单肢对接式移植物 ,经股总动脉或髂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血流通道 ,将动脉瘤隔绝。结果 遇到的技术性问题主要有 :输送器导入困难、SG释放困难、输送器退出困难、SG主体 -单肢连接困难、定位不准确、植入后髂动脉内流出道不通畅、内漏等。经术中即时处理后 ,最终内漏率为 5 75 %。结论 内漏量可根据DSA时造影剂充盈瘤腔的速度来判断 ,最有效的处理是增加延伸移植物。而术前充分评估、充分准备各种器具、熟悉各种器具的特点及使用方法。

Objective To discuss the experience of using the limb-connect-to-mainbody bifurcated stent-grafts in the treatment of abdominal aortic aneurysms by the therapy of endovascular exclusion, and how to manage when problems in the procedure occurred.Methods Eighty-seven patients with infra-renal abdominal aortic aneurysms received endovascular stent-graft exclusions, the stent-garfts used were limb-connect-to-mainbody bifurcated styles. After the longitudinal incisions inferior to both sides of the groin, sometimes, the oblique incision parallel to the groin ligament, the common femoral arteries or the iliac artery were exposed, and the delivery systems were inserted into the artery and sent to the target segment of the aorta. After the deployment, the limb was connected with the mainbody, a bifurcated graft that made the new blood canal excluded the aneurysm sac out of the blood flow.Results Technical problems were mainly as follows,there was difficulty when inserting the dilivery system into the femoral artery, difficulty in deployment, difficulty in removing of the deliverry system, difficulty when the bilateral limb was connected to the mainbody, dislocation of the SG, unpatent out-flow,and endoleak, etc. All the technical problems were managed well, and most of the endoleaks were sealed, the final leakage ratio was 5 75%.Conclusion The volume of the endoleaks might be evaluated by how fast of the contrast filling the aneurysm sac. The most effective method to seal the endoleaks is to use the extensions and cuffs. Carefully preoperative evaluation,good preparation of convenient intervention equipments, high skills of catheter techniques, and preparation of the management when problems might occur,all the above will significantly help to the success of the procedure.