Wallstent双支架重叠技术治疗复杂内脏动脉瘤五例

Safety and efficacy of dual-Wallstent stenting in managing complicated visceral aneurysms: initial experience in 5 cases

目的初步评价Wallstent双支架重叠技术治疗复杂内脏动脉瘤的安全性和疗效。方法回顾性分析2012年3月至2013年11月连续收治的5例内脏动脉瘤患者，包括1例脾动脉起始部梭形动脉瘤、1例脾动脉中段囊状动脉瘤、1例腹腔干囊状动脉瘤、1例肝总动脉囊状动脉瘤、1例肠系膜上动脉宽颈动脉瘤。瘤体平均直径（23．0±8．7）mm。5例内脏动脉瘤均行Wallstent双支架重叠植入治疗，术后给予抗血小板药物治疗，术后6个月、1年、2年行CTA（computedtomographicangiography）检查，观察动脉瘤闭塞情况，支架、载瘤动脉和侧支血管和穿支动脉通畅情况。结果5例患者支架均成功植入，术后30d内1例腹腔干动脉瘤患者出现轻微腹痛，给予止痛、扩血管药物等对症处理后1周后症状消失，余患者无其他手术相关并发症发生。5例患者术后随访6—24个月（平均13个月），动脉瘤均较前均缩小或消失。其中1例肝总动脉囊状动脉瘤患者术后6个月CTA显示支架内轻度狭窄（狭窄〈25％）同时合并部分穿支动脉闭塞，但无明显临床症状，余患者支架、侧支血管和穿支动脉均通畅。结论Watlstent双支架重叠技术植入治疗复杂内脏动脉瘤具有较好的技术成功率和疗效，侧支血管和穿支动脉长期通畅率较高。

Objective To evaluate the safety and efficacy of overlapped dual Wallstent stents technique in managing complicated visceral artery aneurysms. Methods During the period from March 2012 to Nov. 2013, 5 patients with complicated visceral artery aneurysms were admitted to authors＇ hospital The lesions included fusiform aneurysm at the splenic arterial origin （n = 1）, sac-form aneurysm at the middle segment of splenic artery （n = 1）, sac-form aneurysm at celiac trunk artery （n = 1）, sac-form aneurysm at common hepatic artery （n = 1 ） and wide-necked aneurysm of superior mesenteric artery （n = l ）. The clinical data and the imaging materials were retrospectively analyzed. The mean diameter of the aneurysms was （23 ~ 8.7） mm. Overlapping stenting with 2 Wallstent stents was carried out in all patients, and postoperative anti- platelet therapy was employed. CT angiography was performed at 6 months, one year and 2 years after the treatment to evaluate the obstruction condition of the aneurysms, the patency situation of the parent arteries, side branches and perforator arteries, etc. Results Stent implantation was successfully accomplished in all 5 cases. One patient with aneurysm at celiac trunk artery developed mild abdominal pain 30 days after the treatment, which was relieved by administration of vasodilators and analgesic in 1 week. No procedure-related complications occurred in other patients. All the patients were followed up for 6 - 24 months （mean of 13 months）. Shrinkage or disappearance of aneurysms was observed in all the 5 cases. Asymptomatic mild in-stent stenosis （less than 25%） of parent artery and occlusion of several perforator arteries were observed in one patient with sac-form aneurysm of common hepatic artery 6 months after the treatment. In the remaining patients the stents, side branches and perforator arteries remained patent. Conehtsion For the treatment of complicated visceral artery aneurysms, overlapped dual Wallstent stents technique has excellent efficacy and higher technical success rate, besides, long-term patency rate of side branches and perforator arteries is also very high.（J Intervent Radiol, 2014, 23： 1036-1040）