腹主动脉瘤腔内隔绝术后迟发型远端内漏Ⅱ期腔内治疗

Second-stage endovascular repair of the delayed distal endoleak after stent-graft exclusion for abdominal aortic aneurysm

目的 探讨腹主动脉瘤 (AAA)腔内隔绝术EVE后迟发型远端内漏的Ⅱ期腔内治疗方法的价值。方法 为 3例AAAEVE 3年以后迟发型远端内漏患者进行了Ⅱ期延伸移植物置入治疗 ,2例经双侧股动脉切开、两侧各置入 1枚延伸移植物 ,1例经腹膜后径路和股动脉径路完成 3枚延伸移植物置入。结果 3例均应用了贯穿导丝牵张技术 ,延伸移植物置入完成后均将内漏消除。结论 Vanguard支架 人造血管系统的结构特点可能是导致远期远端内漏的原因 ;延伸移植物是治疗的有效方法。导丝牵张技术有助于手术成功并节约手术时间。

Objective To evaluate the second stage endovascular repair of the delayed distal endoleak after stent graft exclusion for abdominal aortic aneurysm.Methods Distal endoleak occurred in three patients with abdominal aortic aneurysm who had undergone the endovascular exclusion more than three years. All of them received the extension stent grafts deployment. The procedures were operated via the bilateral common femoral arteries in two of the cases with one extension stent graft on each side, and via the left retro peritoneal route plus right common femoral artery in another one. Three with extensions applicated. Results With the application of guide wire stretching technique, all the endoleaks were sealed after the additional deployment of extensions. Conclusions The unsteady character of the Vanguard stent graft might be the cause of distal endoleak. Utility of additional extension is the most valuable therapy. Application of guide wire stretching technique is much helpful to achieve the success of the procedure and shorten the operation time.