腹主动脉瘤腔内隔绝术导入动脉相关并发症的认识和处理

Recognition and management of the complications relative to the access arteries in endovascular exclusion for abdominal aortic aneurysms

目的 探讨腹主动脉瘤 (AAA)腔内隔绝术 (EVE)中导入动脉相关并发症的的处理方法。方法 自 1997年 3月至 2 0 0 2年 10月共对 136例AAA实施了EVE ,导入动脉主要相关并发症有导入动脉不良 (包括动脉冗长扭曲、直径过细、局部狭窄或闭塞 )、导入动脉阻控过久、导入动脉毁损或破裂等。针对不同情况采用了经髂动脉导入、导丝牵引技术、球囊扩张、主 单髂型移植物、不完全导入动脉阻断法、导入动脉修复重建等多种技术和处理方法。结果 4 1例导入动脉不良者均顺利完成手术 ;12 3例采用导入动脉不完全阻断法 ,未发生下肢缺血并发症 ;全组因导入动脉相关并发症死亡 2例。结论 重视术前对导入动脉的评估 ,采用针对性的处理方法 。

Objective To assess our experiences of recognition and management of the complications relative to the access arteries in endovascular exclusion (EVE) for abdominal aortic aneurysms (AAA). Methods 136 patients with AAA underwent EVE between March 1997 and October 2002. The main complications relative to the access arteries were poor access artery (including small diameter, tortuosity, stenosis and occlusion), long time blocking of the access arteries, destruction and rupture of the access arteries. Various techniques, including through the iliac artery access, guidewire stretch technique, balloon dilatation, aorto uniiliac graft, partial blocking of the access arteries and repair or reconstruction of the access arteries, were applied according to the different situations. Results The EVE procedure was technically successful in all 41 cases with poor access arteries. The method of partial blocking of the access arteries was used on 123 cases without any lower limb ischemic complications. Two patients died from the complications relative to the access arteries. Conclusions Careful assessment of the access arteries preoperatively and proper management are helpful to recognize and overcome the complications relative to the access arteries.