CTA判断主动脉瘤管腔内修复术术后内漏

Application of Computed Tomography Angiography in the Identification of Endoleaks after Endovascular Aortic Aneurysm Repair

目的分析应用CTA技术观察主动脉瘤腔内修复治疗(Tndovascular Aartic Aneurysm Repair,EVAR)术后内漏。方法针对主动脉瘤EVAR术后行CTA复查、临床资料完整病例进行回顾性分析,借助PACS观察支架置入后有无内漏、发现内漏后判断其来源并做出内漏分型,判断EVAR前后动脉瘤变化情况和与支架节段相关血管并发症。结果 52例主动脉瘤EVAR术后复查病人,平均年龄(68.92±22.73)岁,可见15例(28.85%)16处内漏,其中Ⅰb型1例(1.9%)、Ⅱ型7例(13.46%)、Ⅲ型7例(13.46%)8处;8例原动脉瘤显示增大,密切随访中;1例内漏同时发生原动脉瘤破裂、病危出院;1例胸主动脉EVAR术后2月,发生腹主动脉瘤破裂死亡;3例发生支架局部感染需相应治疗,其中1例需切除支架并截肢。结论现代EVAR术后应用CTA复查,应重视Ⅱ、Ⅲ型内漏的发生;支架发生感染、原动脉瘤破裂可导致严重后果。

Objective To investigate the application of computed tomography angiography(CTA)in the identification of endoleaksafter endovascular aortic aneurysm repair.Methods We retrospectively analyzed the clinical data of patients with aortic aneurysmwho underwent endovascular repair(EVAR)and CTA reexamination in the follow-up duration.The occurrence of endoleak afterstent implantation as well as the change of aneurysm,and its complication relative to the stent-graft segments were observed.ResultsFifty two patients with mean age of(68.92±22.73)years old who underwent aortic aneurysm treated with EVAR were included.Of these patients,15cases(28.85%)were observed with16sites of endoleak on or nearby the stent-grafts.Among them,1case(1.9%)showed typeⅠb,7cases(13.46%)showed typeⅡand7cases(13.46%)with8sites showed typeⅢ.For the15patients withendoleaks,8cases were found bigger aneurysm than that before EVAR,so they were followed-up closely;1case showed aneurysmrupture on stent-graft segment and given-up of treatment;1case died with rupture of abdominal aneurysm after2months followthe chest EVAR;3cases complicated infection of aneurysm on the segment of stent-graft and one of them had to be amputated afterremoval of the stent-graft.Conclusion After EVAR surgery,patients with aortic aneurysm should be followed up by CTA,to identifythe types of endoleaks of stent-grafts.Attention should be payed to the typeⅡandⅢ,as well as the infection and rupture of stentgrafts,which can result in serious consequences.