腔内隔绝术治疗胸主动脉假性动脉瘤16例临床分析

Treatment of aortic pseudoaneurysm by endovascular graft exclusion

目的探讨主动脉假性动脉瘤的临床特征,评价腔内隔绝术治疗主动脉假性动脉瘤的疗效及安全性。方法 2008年7月至2013年9月于沈阳军区总医院行主动脉腔内隔绝术治疗主动脉假性动脉瘤的患者16例。男13例,女3例,年龄（61.2±11.5）岁。经股动脉切开植入覆膜支架封堵主动脉假性动脉瘤破口,主动脉造影确认疗效;合并严重冠状动脉狭窄的患者,于腔内隔绝术后3~7 d完成经皮冠状动脉介入治疗（PCI）。观察主动脉疾病患者介入治疗的疗效。结果主动脉腔内隔绝术操作成功率为100%,共植入14枚主体覆膜支架及4枚短体覆膜支架,16例患者均无残余内漏。1例患者部分封闭左锁骨下动脉开口,左上肢血供无缺血症状。2例冠状动脉严重病变患者,1例行冠状动脉旁路移植术,1例行植入支架治疗。围术期无出血、心肌梗死、死亡等并发症。术后平均随访（68±29）个月,随访率为87.5%（14/16）。1例患者术后3个月发生脑出血,1例患者术后6个月发现胃癌化疗治疗病情稳定,于术后12个月发生截瘫,目前已失去行动能力。冠心病患者无心绞痛发作,无复查冠状动脉造影患者,无MACE发生。随访期间共死亡患者4例（25%）,明确主动脉血管破裂死亡2例（12.5%）。结论主动脉腔内隔绝术治疗主动脉假性动脉瘤,创伤小、近期及长期疗效好,并发症低。合并冠心病患者择期二次行PCI安全可行。

Objective To investigate the clinical characteristics of aortic pseudoaneurysm, and evaluate the in-hospital and long-term effectiveness, and safety of endovscular graft exclusion in treating aortic pseudoaneurysm. Methods From July 2008 to September 2013, a total of 16 patients（13 males and 3 females; mean age： 61.2±11.5 years） with aortic pseudoaneurysm underwent stent graft implantation. The anterior walls of femoral artery were cut, and the stent grafts were placed to close dissection tears and repaired aneurysm. All patients underwent angiography for confirmed effect after stents graft implantation. The patients with coronary heart disease（CHD） were performed stent graft implantation 3-7 days before they underwent percutaneous coronary intervention（PCI）. Then the clinical efficacy was analyzed. Results Procedures were technically successful in all patients. A total of 14 trunk stent grafts and 4 cuff stent grafts were used. All the 16 patients were found with endoleak. In only 1 patients, the left subclavian artery was partially covered by the proximal section of the graft, but the left arm had no ischemic symptoms. For 2 patients with severe CHD, one was treated by coronary artery bypass graft（CABG）, and the other by PCI. All the patients were followed up for an average of 68±29 months. The rate of following up was 87.5%（14/16）. During following up, cerebral hemorrhage occurred in 1 patient after 3 months. One case was found with gastric cancer postoperative 6 months and received chemotherapy. But paraplegia occurred in this patient after 12 months, and he had lost the ability to act. In patients with CHD, angina did not occur and there were no patients receiving re-examination of coronary artery angiography. Major adverse cardiac event（MACE） did not occur either. Four patients died during following up（25%）, of whom 2 cases died of aortic vascular rupture（12.5%）. Conclusion Endovascular graft exclusion is effective in treatment of aortic pseudoaneurysm with lower complications. It is safe and feasible to treat aortic pseudoaneurysm complicated with CHD by combination of endovascular repair and PCI, and the occurence rate of MACE is lower.