纤维蛋白粘合剂配合无造影剂腔内隔绝术治疗腹主动脉瘤短期疗效分析

The short-term efficacy of endovascular aneurysm repair with fibrin sealant combined with no contrast agent on patients with abdominal aortic aneurysm

目的观察纤维蛋白粘合剂(FS)+无造影剂腔内隔绝术(EVAR)治疗肾功能不全和(或)造影剂过敏的腹主动脉瘤(AAA)病人的短期疗效。方法行无造影剂EVAR+FS治疗AAA病人5例,均为慢性肾功能不全和(或)有造影剂过敏病史。Ⅰ型AAA 1例,ⅡA型AAA 4例,近端瘤颈长度(19.6±3.6)mm。术前用Endosize工作站对肾动脉和髂内动脉进行骨性定位,术中使用标记导管。EVAR术后,瘤腔内测压并注射FS治疗内漏,直至收缩压和脉压差的平均压力指数(MPI)<35.0%。薄层CT平扫+超声随访观察疗效。结果病人均顺利完成无造影剂EVAR。2例无需注射FS,3例FS注射后MPI降至35.0%以下。平均随访时间为16.4个月。超声检查提示5例病人瘤腔内全部血栓化,无内漏。CT平扫提示术后AAA最大直径3例无明显变化,2例分别减少4mm和3mm。没有病人出现肾功能恶化,无截瘫、肠坏死、臀性跛行及AAA破裂。结论 FS配合无造影剂EVAR治疗肾功能不全和(或)造影剂过敏病人的短期疗效满意,但需严格掌握适应证和禁忌证。

Objective To observe the short-term efficacy of endovascular aneurysm repair（EVAR）with human fibrin sealant（FS）combined with no contrast agent on patients with abdominal aortic aneurysm（AAA）and renal insufficiency or allergy of contrast agent.Methods A total of 5 patients with AAA and renal insufficiency and/or allergy of contrast agent were received EVAR＋FS with no contrast agent in Changhai Hospital from 2014 to 2016,which included 1 case with type I AAA and 4 cases with type IIA AAA.The proximal aneurysm neck was（19.6±3.6）mm.Renal and internal iliac arteries were located with lumbar vertebrae by Endosize workstation,and renal artery was located by marked catheter.After EVAR,the pressure measurement and FS injection for treating endoleak were performed until the mean pressure indexes（MPI）was less than 35%.The short-term efficacy was evaluated by CT scanning and ultrasound during the follow-up.Results All the patients were successfully performed EVAR with no contrast agent.No FS injection was needed in 2 cases.The MPI fell to 35%in three cases after FS injection.During the average 16.4-months follow-up,there was no endoleak in all patients.And CT scanning showed no difference in the maximum diameter in 3 cases,and reduction by 4 mm and 3 mm in the maximum diameter in 2 cases.No deterioration of renal function was found in all patients as well as paraplegia,intestinal necrosis,gluteus intermittent claudication and rupture of AAA.Conclusion The short-term efficacy of EVAR with FS combined with no contrast agent on patients with renal insufficiency and/or allergy of contrast agent is satisfactory,while the indication and contraindication should be strictly controlled.