腹主动脉瘤合并急性主动脉综合征患者行同期腔内修复术的效果

Efficacy of endovascular repair in patients with abdominal aortic aneurysm complicating acute aorticsyndrome

目的探讨同期腔内修复术治疗腹主动脉瘤（AAA）合并急性主动脉综合征（AAS）的效果。方法回顾性分析北京安贞医院2010年9月至2015年6月期间行同期腔内修复术的17例AAA合并AAS患者的临床资料。其中，男性16例，女性1例；年龄（65.2±6.9）岁。AAA合并AAS经全主动脉CT血管成像诊断，腹主动脉病变均为AAA，胸主动脉病变均为AAS。局部麻醉下行同期胸腹主动脉腔内修复术，其中2例为急诊手术。术后1、3、6个月及每年定期随访。结果患者均取得手术技术成功，胸主动脉支架覆盖长度为（21.0± 4.6） cm。手术时间为150（120，170） min，住院时间为7（6，12） d。术后随访27.0（5.5，44.5）个月，随访期间未发生严重心肺并发症及对比剂肾病。1例患者术后即出现脊髓缺血，治疗后病情缓解。1例患者术后半年因急性主动脉破裂死亡。1例患者于术后9个月因右侧髂动脉扩张，发生Ⅰb型支架内漏，置入髂腿延长支架后病情缓解。结论同期胸腹主动脉腔内修复术是治疗AAA合并AAS的有效方法，可为多水平主动脉病变提供一种安全可行的治疗选择。

Objective To evaluate the efficacy of simultaneous thoracic endovascular aortic repair （TEVAR） and endovascular aneurysm repair （EVAR） on abdominal aortic aneurysm （AAA） patients complicating acute aortic syndrome （AAS）. Methods Data of 17 patients （ 16 men, mean age （65.2 ±6. 9） years old） , who underwent simultaneous TEVAR and EVAR between September 2010 and June 2015 in Beijing Anzhen Hospital, were retrospectively reviewed. All patients were diagnosed with concomitant AAA and AAS by preoperative CTA. All abdominal aortic lesions were AAA and all thoracic aortic lesions were AAS. Under local anesthesia, simultaneous TEVAR and EVAR were performed and emergent simultaneous endovascular repair was performed in 2 patients. Follow up was made at 1 month, 3 months, 6 months, and yearly after the procedure. Procedure success rate, procedure related complications were evaluated. Results Procedure was successful in all patients. The length of thoracic coverage was （21.0 ± 4. 6 ） cm. The operation time was 150（120,170） min, and the hospitalization time was 7 （6,12） d. After a mean of 27.0 （5.5, 44. 5 ） months follow up, there were no acute cardiopulmonary complications and contrast induced nephropathy. One patient developed spinal cord ischemia and resolved after treatment. One patient was died for aneurysm rupture at 6 months post operation. One patient developed type I b endoleak for expansion of right iliac artery at 9 months post operation and was successfully sealed by iliac stent-graft extension. Conclusions Combined TEVAR and EVAR can be performed successfully in patients with AAA complicating AAS. When anatomically feasible, simultaneous TEVAR and EVAR can be considered as a effective and safe therapy alternative to patients with muhilevel aortic diseases.