低渗透设计GORE EXCLUDER覆膜支架在复杂腹主动脉瘤腔内治疗中的应用

Application of low permeability GORE EXCLUDER aortic covered stent graft to endovascular treatment of complex abdominal aortic aneurysm

目的评价低渗透设计GORE EXCLUDER覆膜支架腔内治疗复杂腹主动脉瘤的安全性和有效性。方法 2011年4月—2014年4月应用低渗透设计GORE EXCLUDER覆膜支架腔内治疗复杂腹主动脉瘤21例,收集患者资料并进行回顾性分析。结果 21例患者中,男19例,女2例;年龄55~87岁,中位数为72.34岁。本组病例存在以下1种或多种情况：合并髂动脉瘤10例,巨大动脉瘤4例,短瘤颈3例,瘤颈严重扭曲3例,入路严重扭曲4例,股动脉纤细1例,附壁血栓和严重钙化6例。21例手术均获成功,无中转开腹及术中死亡病例,2例术后住院期间死于合并症。手术时间（135.43±12.45）min,术中出血量为（180.24±21.66）m L,均无输血。术中Ⅰ型内漏5例,Ⅱ型内漏3例,Ⅲ型内漏2例,均术中处理满意。术后随访19例,随访时间为3~36个月,18例存活,1例死于糖尿病并发症。随访患者术后均复查CT血管造影,未发现与支架相关的并发症。结论低渗透设计GORE EXCLUDER覆膜支架腔内修复适用于多数复杂腹主动脉瘤患者的治疗,手术风险较低,术中和术后并发症较少,具有良好的安全性和有效性。

Objective To evaluate the safety and effectiveness of the lowpermeability G O RE EX CLU DER aortic covered stent graft for endovascular treatment of complex abdominal aortic aneurysm（ AAA）.Methods The data of 21 cases of complicated AAA that underwent the endovascular treatment with lowpermeability G O RE EX CLU DER aortic covered stent graft fromApril, 2011 to April, 2014 were selected and retrospectively analyzed.Results Among 21 patients, 19 of themwere males and 2 of themwere females.Their ages were between 55 and 87 and the median age was 72.34.Complex AAA included one or more of the following circumstances： combined iliac artery aneurysm（ 10 cases）, giant aneurysm（ 4 cases）, short neck（ 3 cases）,neck severe twisted（ 3 cases）, approach seriously distorted（ 4 cases）, femoral artery slim（ 1 case）, and mural thrombus and severe calcification（ 6 cases）.Operations of all cases were successful without laparotomy and intraoperative deaths and 2 cases died fromcomplications during postoperative hospital stay.Operation time was（ 135.43 ± 12.45） min and the intra-operative blood loss was（ 180.24 ± 21.66） mL.N o blood transfusion was conducted.There were 5 cases of intra-operative endoleak typeⅠ, 3 cases of endoleak type Ⅱ, and 2 cases ofendoleak type Ⅲ.The intra-operative treatment of all cases was satisfactory.A total of 19 patients were followed up for 3- 36 months and 18 of themsurvived and one patient died fromthe diabetic complication.All postoperatively followed up patients had undergone the computed tomography angiography（ CTA） and no significant complications relevant to stents were found.Conclusion The lowpermeability GORE EXCLUDER aortic covered stent graft is suitable for the treatment of most patients with complex AAA and the safety and effectiveness are satisfactory due to lowsurgical risk and less intraoperative and postoperative complications.