肾下腹主动脉瘤近端瘤颈形态与ⅠA型内漏的相关性研究

Influence of Proximal Aneurysm Neck Anatomy on Type ⅠA Endoleak Following Endovascular Repair for Infrarenal Abdominal Aortic Aneurysm

目的探讨腹主动脉瘤近端瘤颈的形态对ⅠA型内漏发生的影响。方法 2007年9月至2014年2月期间我院对收治的111例非破裂肾下腹主动脉瘤患者行腔内修复术,所有患者术前均行腹部动脉CT血管造影(CTA)检查,利用Osorix软件将所获得的CTA图像进行三维重建及测量,术后第3、6、12个月及以后每年复查,分析腹主动脉瘤近端瘤颈形态的相关指标与ⅠA型内漏发生的关系。结果本组有14例发生ⅠA型内漏,单因素分析结果显示,近肾动脉段瘤颈的直径变化率、近瘤体段瘤颈的变化率、近端瘤颈长度、附壁血栓及钙化与ⅠA型内漏的发生无关(P>0.05),而近端瘤颈夹角和瘤体最大直径与ⅠA型内漏的发生有关(P=0.04,P=0.04);进一步多因素logistic分析结果显示,仅近端瘤颈夹角与ⅠA型内漏有关(P=0.002)。采用不同公司的支架对ⅠA型内漏的发生率比较差异亦无统计学意义(P>0.05)。结论从本研究结果初步得出,形态复杂的近端瘤颈是影响ⅠA型内漏发生的重要原因,其中近端瘤颈夹角是独立影响因素,腔内修复术是否适用于治疗非破裂肾下腹主动脉瘤在很大程度上取决于近端瘤颈的形态。

Objective To determine the influence of proximal aneurysm neck anatomy on type ⅠA endoleak following endovascular aortic aneurysm repair（EVAR） for infrarenal abdominal aortic aneurysm. Methods From September2007 to February 2014, 111 consecutive patients with non-ruptured abdominal aortic aneurysms were treated with EVAR.The preoperative CTA of abdominal aortic was obtained by every patient, and the three-dimensional imaging was reconstructed and measured by software of Osorix. Then, the relation between the recurrence of type ⅠA endoleak and the concerned data measured by Osorix was analyzed by the statistical software. Results The recurrence of type ⅠA endoleak was related to the proximal neck angle of the abdominal aortic aneurysm, which weren＇t related to the proximal neck diameter and variation rates, the mural thrombas and calcification rate, and the maximum diameter of abdominal aortic aneurysm by multivariate analysis. Conclusions The complicated proximal aneurysm neck anatomy is a major cause for the type ⅠA endoleak, the proximal neck angle of the abdominal aortic aneurysm is the independent factor. The application of EVAR depends largely on the shape of the proximal aneurysm neck.