覆膜支架和密网支架在复杂内脏动脉瘤的治疗应用(附12例病例分析)

The Application of Covered Stent and Low-Porosity Stent in Managing Complicated Visceral Arterial Aneurysms: Initial Experience in 12 Cases

目的评价覆膜支架和密网支架在复杂内脏动脉瘤治疗中的安全性和疗效。方法回顾分析12例内脏动脉瘤患者(脾动脉瘤6例,腹腔干动脉瘤3例,肠系膜上动脉动脉瘤2例,肠系膜下动脉瘤1例)临床及影像学资料,其中6例脾动脉动脉瘤患者行覆膜支架置入治疗,余6例行密网支架重叠置入,所有患者术后均给予抗凝治疗。术后1个月、6个月、1年、2年行CTA检查观察动脉瘤闭塞情况及支架和载瘤动脉通畅情况。结果 12例患者支架均成功置入,6例脾动脉瘤患者覆膜支架置入后造影显示支架管腔通畅,动脉瘤未再显影;其余6例内脏动脉瘤患者密网支架重叠置入后造影显示动脉瘤显影浅淡或基本不显影,穿支动脉未累及。术后近期随访(1个月),1例出现轻度腹痛,给予对症处理后症状消失,所有患者均未见动脉瘤破裂,支架内急性血栓形成等严重并发症。远期随访6例覆膜支架置入患者动脉瘤均未再显影,无内漏及支架内狭窄;6例密网支架置入者动脉瘤较前均缩小或消失,其中1例CTA显示支架轻度狭窄,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、穿支动脉均通畅。结论覆膜支架和密网支架置入是治疗复杂内脏动脉瘤的安全、有效方法。

Objective To evaluate the safety and efficacy of the placement of covered stent and low-porosity stent in treating complicated visceral artery aneurysms. Methods During the period from January 2012 to January 2014, a total of 12 patients with visceral artery aneurysms were treated at authors＇ department. The diseases included splenic aneurysm （ n = 6）, celiac aneurysm （ n = 3 ） , superior mesenteric artery aneurysm （ n = 2） and inferior mesenteric artery aneurysm （ n = 1 ）. Implantation of covered stem was employed in 6 patients with splenic aneurysm and overlapping placement of low- porosity stent was used in the other 6 patients. Postoperative antithrombotic therapy was adopted in all patients. CT angiog- raphy was performed at one and 6 months as well as at one and 2 years after the treatment to check the aneurysm, parent ar- tery and stent patency. The clinical data and imaging materials were retrospectively analyzed. Results The implantation of stent was successfully accomplished in all 12 patients. In 6 patients with splenic aneurysm, postoperative angiography showed that the stent lumen was patent and the aneurysm was no more visualized. In the remaining 6 patients with visceral artery aneurysm, angiography performed after low-porosity stent overlapping implantation revealed that the aneurysm was faintly visualized and the perforating arteries were not involved. One month after the procedure one patient developed mild abdominal pain, which disappeared after symptomatic medication. No severe complications such as rupture of aneurysm, a- cute in-stent thrombosis, etc. were observed in all patients. Long-term follow-up showed that in 6 patients receiving cov- ered stent implantation the aneurysm was no more visualized, and no endoleak or in-stent stenosis occurred; in 6 patients receiving low-porosity stent overlapping implantation the aneurysm became smaller or even disappeared, in one of them CT angiography revealed mild in-stent stenosis （ 〈 25% ） associated with obstruction of several perforating arteries, but clini- cally the patient had no any symptom. In the remaining patients the stent and the perforating arteries were complete patent.Conclusion The implantation of covered stent and low-porosity stent is a salh and effective alternative fiw the treatment of complicated visceral artery aneurysms.