腹主动脉瘤腔内治疗的历史与进展

History and progress of endovascular treatment for abdomi- nal aortic aneurysm

腹主动脉瘤的传统治疗为开腹手术。20世纪90年代腹主动脉瘤腔内治疗（EVAR）开始兴起，早期EVAR受到患者解剖条件、年龄以及器械的限制，适用范围十分有限，其沿用传统的手术指征也影响了治疗效果。其后腔内技术日趋成熟，腔内器械性能不断改善，使EVAR能应用于更加复杂的病变，治疗效果得以提高。目前EVAR发展仍需面对和解决复杂近端瘤颈、术中术后内漏、累及内脏动脉或髂动脉的腹主动脉瘤以及破裂腹主动脉瘤的完全腔内治疗等难题。在探索这些问题解决办法的过程中，烟囱技术、开窗技术、分支支架技术和“三明治”技术等新技术和新器械得以创造和发展。相信在血管外科医师的努力下，EVAR将更加完善，并得到更加广泛的应用。

The traditional treatment of abdominal aortic aneurysm was open surgery. In the 1990s, endovascular abdomi- nal aortic aneurysm repair （EVAR） began to emerge. In the early stage, this kind of minimally invasive method was applied in highly selected patient cohort due to the limitation of anatomic conditions of patients, age of patients and shortage of available endovascular devices. The indications for open surgery which were used in this new kind of therapeutic modality also influ- enced the outcomes. As the technique became mature and the properties of endogarft were developed, endovascular treatment can be used to treat more complex pathologies and the results were improved. However, several challenges were rising, inclu- ding dealing with complex proximal aneurismal neck, intra- and post-operative endoleak, abdominal aortic aneurysm compromi- sing branched arteries and ruptured abdominal aortic aneurysm. To solve these problems, chimney technique, fenestrated stent, branched stent and the sandwich technique had been invented and developed. It is believed that endovascular treatment for abdominal aortic aneurysm could be applied more widely under vascular surgeons＇ efforts.