腹主动脉瘤腔内修复术中弹簧圈联合纤维蛋白胶瘤腔填充技术预防术后Ⅱ型内漏

Intraoperative sac embolizaion with coils and fibrin glue during endovascular aneurysm repair for preventing postoperative type Ⅱ endoleak

目的探讨腹主动脉瘤腔内修复术(endovascular aneurysm repair,EVAR)中弹簧圈联合纤维蛋白胶填塞瘤腔预防术后Ⅱ型内漏的技术可行性和有效性。方法对1例存在Ⅱ型内漏高危风险的腹主动脉瘤患者,为预防EVAR术后Ⅱ型内漏,在术中于瘤腔内联合填塞弹簧圈和纤维蛋白胶,同时术中采取经皮导管预置、球囊阻断等技术以确保材料精准填塞。结果手术结束时造影显示支架及远端动脉血流通畅,未见Ⅰ、Ⅲ型内漏,延迟显影未见瘤腔侧支反流血,手术成功。患者手术时间为118 min,术中出血量20 mL。术后患者无结肠缺血、异位栓塞等并发症发生,于术后3 d顺利出院。术后6个月随访CT血管三维重建提示瘤腔完全血栓化,未见Ⅱ型内漏,瘤腔直径和体积均缩小。结论EVAR术中弹簧圈联合纤维蛋白胶填充瘤腔技术预防术后Ⅱ型内漏安全有效,且操作简单、可行性强,术中经皮瘤腔留置导管及球囊适时阻断是该技术成功实施的关键点。

Objective To investigate the technical feasibility and effectiveness of intraoperative sac embolizaion with coils and fibrin glue for preventing typeⅡendoleak after endovascular aneurysm repair(EVAR).Methods A patient with abdominal aortic aneurysm(AAA),which had high risk of type Ⅱ endoleaks,was treated with combined packing of coils and fibrin glue in order to prevent type Ⅱ endoleak after EVAR.Percutaneous catheter preset and balloon occlusion were used to ensure accurate packing.Results At the end of the operation,the angiography showed that the blood flow of the stent and distal artery was unobstructed,there was no type Ⅰ and Ⅲ endoleaks,and delayed angiogram showed no collateral circulation of aneurysm.The procedure was successful.The operative duration was 120 min and the blood loss was only 20 mL.No complications such as colonic ischemia and ectopic embolism occurred,and the patient was discharged on 3 days after operation.At 6 months after follow-up,the computerized topographic angiography showed that the aneurysm cavity was completely thrombotic,without type II endoleak,and the diameter and volume of aneurysm were reduced.Conclusions The technique of intraoperative sac embolizaion with coils and fibrin glue during EVAR is safe and effective to prevent postoperative endoleaks,which is simple and feasibility.Intraoperative indwelling catheter and balloon blocking are the key points of successful implementation of this technique.