腹主动脉瘤腔内隔绝术后瘤体变化

Fate of aneurysmal sac after endovascular exclusion of abdominal aortic aneurysms.

目的 :探讨腹主动脉瘤 (AAA)腔内隔绝术 (EVE)后瘤体变化规律 ,并讨论其机理。方法 :随访1997年 3月到 2 0 0 2年 10月间 136例实施EVE的病例 ,分别于术后出院前 ,第 3、6、12、18、2 4个月 ,及以后每年一次行CTA检查。观察有无内漏 ,测量动脉瘤最大直径。结果 :10 5例获得完整资料 ,在随访期间有 5 5例瘤体缩小 ,其中 1例证实有内漏 ;瘤体缩小多在 6个月左右出现。 12例瘤体增大 ,其中 11例证实有内漏 ,1例原因不明。 38例瘤体大小稳定 ,其中 1例有内漏。结论 :EVE术后瘤体变化受多因素影响 ;内漏是瘤体增大主要原因。腔内隔绝术后瘤体缩小是术后瘤内压降低后瘤壁的重塑过程而不是弹性回缩。

Objective:To determine the effect of endovascular exclusion on the size of abdominal aortic aneurysms and to discuss the underlying mechanisms.Methods:136 patients with AAA undergoing endovascular exclusion were followed up for 10 to 77 months with spiral CT angiography.Diameters of aneurysms were measured postoperatively at 0,3rd,6th,12th,18th,24th month and each year thereafter.Results:Of 105 patients with integral data,55 patients exhibited aneurysm shrinkage beginning at the 3 to 6 months postoperative time.A patient with endoleak also presented with decreased aneurysm size.Twelve aneurysms enlarged continually after EVE,of which, 11 cases were proven to have endoleak while the cause of one case was unknown.Other 38 aneurysms had no detectable size changing during the follow-up period.Conclusion:Fate of AAA sac sizes was determined by multi-factors besides endoleak.Delayed aneurysm shrinkage indicated that it was a tissue remodeling process rather than elastic recoil.It was not necessary that intra-sac pressure lower than extra-sac for aneurysm shrinkage since some aneurysms with endoleak also presented with size decreasing.