Viabahn^(TM)自膨式覆膜支架腔内修复外周动脉创伤性假性动脉瘤

Endovascular repair of peripheral traumatic pseudoaneurysm with Viabahn^(TM) self- expanding covered stent

目的探讨采用Viabahn TM自膨式覆膜支架腔内修复外周动脉创伤性假性动脉瘤(TPA)的可行性、安全性和有效性。方法回顾性分析2012年4月至2014年6月上海长征医院血管外科收治的8例外周动脉TPA患者,病变位于颈总动脉4例,椎动脉1例,锁骨下动脉1例,股浅动脉2例。依据急性和慢性TPA分类及不同原则处置,8例患者均接受ViabahnTM自膨式覆膜支架腔内修复术。术中记录造影表现、植入支架尺寸及数目、支架植入后即刻造影结果。术后随访观察患者症状改善、瘤腔修复效果及内漏或再狭窄发生情况。结果 8例患者均成功植入Viabahn TM自膨式覆膜支架,技术成功率为100%。所有患者术后即刻造影提示瘤腔完全修复,载瘤动脉远端通畅,无对比剂内漏。术后平均随访14.3个月(6~30个月),所有患者症状消失,CTA检查提示无内漏或再狭窄发生。结论根据分类处置原则,采用ViabahnTM自膨式覆膜支架腔内修复外周动脉TPA,具有操作微创简易、可行性好、疗效确切、兼具较好安全性的优点,可作为处理外周动脉TPA的一线治疗方案。

Objective To discuss the feasibility, safety and validity of the use of ViabahnTMself-expanding covered stent in endovascular repair of peripheral traumatic pseudoaneurysm（TPA）. Methods During the period from June 2012 to April 2014, a total of 8 patients with peripheral TPA were admitted to the Department of Vascular and Endovascular Surgery of Shanghai Changzheng Hospital. The clinical data were retrospective analyzed. The lesions were located at the common carotid artery（n =4）, vertebral artery（n=1）, subclavian artery（n=1） and superficial femoral artery（n=2）. On the basis of acute and chronic TPA classification and different therapeutic principles, endovascular repair with ViabahnTMself- expanding covered stent was employed in 8 patients. Intraoperative angiographic findings, the size and number of the implanted stent, and the immediate angiographic results after stent implantation were recorded. All the patients were followed up to evaluate the improvement of the symptoms, the effectiveness of the repair of TPA cavity, and the occurrence of endoleak or restenosis. Results Successful implantation of ViabahnTMself-expanding covered stent was accomplished in all 8 patients, with a technical success rate of 100%.Angiography performed immediately after stent implantation showed that complete repair of TPA cavity was obtained in all patients, the distal segment of the parent artery was patent, and no endoleak was observed.The sizes of the stent used in the patients were 8×50 mm（n=2） and 9×50 mm（n=2） in common carotid artery,6×50 mm（n=1） in vertebral artery, 11×100 mm（n=1） in subclavian artery, and 8×100 mm（n=2） in superficial femoral artery. The patients were followed up for 6-30 months（mean of 14.3 months）, and the clinical symptoms disappeared in all patients. CT angiography indicated that there was no endoleak or restenosis.Conclusion Based on the different therapeutic principles, the use of ViabahnTMself- expanding covered stent in endovascular repair of peripheral TPA is technically simple and micro- invasive, and clinically feasible with reliable effect and safety. Therefore, this technique can be employed as a first- line therapy option for peripheral TPA.