术中开窗支架技术治疗近肾腹主动脉瘤

Physician-modified fenestrated stent-grafts for juxtarenal aortic aneurysms

目的初步探讨术中开窗技术治疗近肾腹主动脉瘤的安全性和有效性。方法回顾性分析2018年7月至2020年7月南京大学附属鼓楼医院血管外科应用术中开窗支架技术治疗的18例近肾腹主动脉瘤患者的临床资料。结果18例近肾腹主动脉瘤患者均采用术中开窗/分支支架技术进行腔内修复治疗,术中内脏动脉重建技术成功率为100%,无Ⅰ型内漏,3例Ⅱ型内漏,1例Ⅲ型内漏;无围术期死亡病例,无二次手术干预病例;手术时间为(188.6±60.1)min,住院天数为(7.7±5.4)d。术后中位随访时间为12.5(1,24)个月,靶血管通畅率为100%;3例Ⅱ型内漏均消失,1例Ⅲ型内漏的动脉瘤直径未见明显变化。结论术中开窗支架技术治疗近肾腹主动脉瘤是安全、有效的。

Objective To preliminarily evaluate the safety and efficacy of fenestrated endovasculer aortic repair(F-EVRA)using physician-modified stent-grafts(PMEG)to treat juxtarenal aortic aneurysms.Methods The clinical data of 18 patients who underwent F-EVRA using PMEG at the Department of Vascular Surgery of Nanjing Drum Tower Hospital from July 2018 to July 2020 were retrospectively analyzed.Results Intraoperative fenestration/branch stent repair was performed in all 18 patients with juxtarenal aortic aneurysms.The success rate of intraoperative reconstruction of visceral artery was 100%,with no typeⅠendoleak,3 cases of typeⅡendoleak and 1 case of typeⅢendoleak.There was no case of perioperative death and secondary surgical intervention.The operative time was(188.6±60.1)minutes and the mean length of hospital stay was(7.7±5.4)days.The median postoperative follow-up time was 12.5(1,24)months.The patency rate of target vessels was 100%.During the follow up,3 cases of typeⅡendoleak disappeared while 1 case of typeⅢendoleak remained,of which the aneurysm diameter did not change significantly.Conclusion F-EVRA using PMEG may be a safe and effective alternative for patients with juxtarenal aortic aneurysms.