弹簧圈在主动脉疾病腔内修复术中的应用

The use of coils in endovascular repair of aortic diseases

目的总结弹簧圈在主动脉疾病腔内修复术中的一期效果。方法回顾性分析2008年9月至2013年12月北京大学人民医院采用腔内修复术联合弹簧圈栓塞治疗的主动脉疾病48例的临床资料，包括腹主动脉瘤32例，主动脉夹层16例。结果所有患者使用的弹簧圈均被成功置入，无中转手术者。1例破裂腹主动脉瘤患者急诊行腔内修复术，术后第2天死于出血性休克致多器官功能衰竭。1例患者TEVAR术后3h突发肺动脉栓塞，术后第2天死于呼吸衰竭。随访时间7～60个月，平均随访（35±5）个月。25例腹主动脉瘤腔内隔绝术并行髂内动脉栓塞者，4例患者出现臀肌缺血性跛行，但未发生臀肌坏死、左半结肠缺血等其他严重并发症。患者术后复查CTA显示主动脉瘤腔血栓形成。主动脉夹层患者中，1例老年男性患者术后7个月死于肺部感染。随访期间无夹层再撕裂或主动脉破裂，术后复查CT血管造影显示主动脉假腔血栓化。两组均无支架或弹簧圈的移位及周边器官的损伤。结论血管腔内修复术中联合弹簧圈的栓塞对于主动脉疾病的治疗是一种补充治疗方法。

Objective To summarize the experience and efficiency of coils in endovascular aortic repair. Methods From September 2008 to December 2013,48 patients received endovascular aortic repair in combination of coil embolization including abdominal aortic aneurysm in 32 patients, and aortic dissection in 16. Results Coils were successfully implanted in all cases. One patient with ruptured abdominal aortic aneurism （AAA） underwent emergency endovaseular aortic repair and died of multiple organ failure the day after surgery. One patient died of pulmonary artery embolization 3 hours after TEVAR. 44 patients were followed up ranging from 7 to 60 months. In AAA group, 25 patients received endovaseular exclusion in combination with internal iliac artery embolization, four of them had claudication due to gluteal ischemia but without other severe complications. Post-operative CTA found endovascular thrombosis in aneurysm. In the aortic dissection group, one patient died of pulmonary infection. During the follow up, there was no AAA dissection, and AAA rupture. Post-operative CT confirmed thrombus in cavity. There were no scaffold and coil transloeation and surrounding tissue injury. Conclusions Endovascular aortic repair in combination with coil embolization is a complementary treatment to aortic diseases.