高危腹主动脉瘤患者腔内修复术并发症分析

Postoperative complications of endovascular repair of abdominal aortic aneurysms in poor-risk patients

目的 总结高危腹主动脉瘤患者腔内修复术中及术后常见并发症及其处理措施.方法 回顾性分析安徽医科大学附属安徽省立医院2008年1月至2013年12月收治的58例高危肾下型腹主动脉瘤患者腔内修复术的临床资料,对术后并发症及其特点进行分析总结.结果 手术技术成功率为96.6％ （56/58）,围手术期并发症发生率为32.8％（19/58）,其中,全身性并发症发生率为19.0％（11/58）,穿刺部位相关并发症发生率为12.1％（7/58）,原发内漏发生率为27.6％（16/58）.本组51例患者获随访,随访率86.2％.随访时间为1～60个月,平均（20±5）个月.并发症发生率为29.4％（15/51）,死亡率为7.8％ （4/51）,再次干预率为7.8％ （4/51）.全身性并发症发生率3.9％（2/51）,继发性内漏发生率为9.8％ （5/51）,支架相关性并发症发生率11.8％（6/51）.结论 内漏,支架相关性并发症仍是高危腹主动脉瘤患者腔内修复术后再次手术的主要原因.

Objective To review the complications after endovascular aneurysm repair （EVAR） of high-risk abdominal aortic aneurysms in our medical center.Methods Fifty eight elective high-risk EVAR cases from January 2008 to December 2013 were analyzed retrospectively.Results The technical success rate was 96.6％ （56 of 58 patients）.The overall complication rate in perioperative period was 32.8％ （19/58）.Eleven systemic complications （19.0％）,16 primary endoleaks （27.6％）,7 access of site complications（12.1％） were observed.The follow-up rate was 86.2％ （51/58）.During the follow up period,the mortality was 7.8％ （4/51）,the re-intervention rate was 7.8％ （4/51）.The overall complication rate was 29.4％ （15/51）,including systemic complications （2/51）,secondary endoleak （9.8％） and graft-related complications （11.8％,6/51）.Conclusions Endoleak,graft-related complications continue to be the main causes of re-intervention in high-risk aneurysm patients after EVAR.