腹主动脉瘤腔内隔绝术中肱股导丝牵张技术的应用

The application of brachial-femoral stretch guidewire in endovascular exclusion of abdominal aortic aneurysm

目的 探讨肱股导丝牵张技术在腔内隔绝术 (EVE)治疗腹主动脉瘤 (AAA)中的操作要点和应用价值。方法 对本中心自 1997年 3月至 2 0 0 2年 10月间施行的 136例AAAEVE进行了回顾性研究。选用主体 单肢对接型移植物者 118例 (Vanguard 6例 ,Talent 86例 ,Aneurx 2例 ,Zenith 3例 ,国产 2 1例 )。使用肱股导丝牵张技术完成操作的共 12例。均使用 0 .0 38英寸的 2 6 0cm长泥鳅导丝经左肱动脉穿刺导入。结果 12例采用肱股导丝牵张技术的手术全部实现移植物顺利导入、连接、释放 ,1例术后出现肱动脉血栓形成 ,1例出现左前臂内侧皮神经损伤 ,未发生左上肢及左侧椎动脉系统的血管并发症和其他切口并发症。其中 9例从手术开始即采用肱股导丝牵张技术 ,从移植物主体导鞘退出到短肢释放完成的时间为 5～ 11min ,平均 7.7min ,明显短于使用其他方法连接移植物短肢所消耗的时间。结论 对于瘤体直径 >6cm且与髂总动脉轴线成角 >4 5°、瘤颈扭曲 >30°或髂动脉扭曲 >4 5°、患者年龄超过 75岁合并一个以上重要脏器功能不全 ,不能耐受长时间手术的AAA患者 ,肱股导丝牵张技术有明显优势。

Objective To investigate the key technique and application value of brachial femoral stretch guidewire in endovascular exclusion of abdominal aortic aneurysms. Methods Since March 1997 to October 2002, endovascular exclusion for abdominal aortic aneurysm had been preformed on 136 patients. The main body short limb graft was used in 118 cases, (Vanguard 6, Talent 86, AneuRx 2, Zenith 3, domestic 21)。12 of these patients were undengone brachial femoral guidewire technique for the proceduce. Results All of the 12 cases with brachial femoral stretch guidewire technique had the stent grafts introduced, connected and released successfully. One case suffered brachial artery thrombosis postoperatively. One case had left medial antebrachial cutaneous nerve injured, but no other artery or incision complications occurred. 9 cases with the brachial femoral stretch guidewire technique showed obviously, shortenning of the time for this procedure.Conclusions For the patients with poor general condition or specific anatomic conditions, such as aneurysm diameter >6cm and the angle between aneurysm and common iliac artery >45°, aneurysm necktwist>30°or iliac artery twist >45°, age over 75 years old and combination with more than one important organ disfunction, the brachial femoral guidewire technique is the valuable method of choice.