腹主动脉瘤腔内隔绝术后内漏的研究

Completion endoleak of endovascular exclusion for AAA in caine

目的 探讨腹主动脉瘤腔内隔绝术后内漏的处理方法。方法 建立犬腹主动脉瘤模型 ,植入自制的腔内移植物建立内漏模型 ,采用瘤腔内注射纤维蛋白胶的方法消除内漏 ,测定瘤腔内压力变化。结果 对照组在腔内隔绝术前瘤腔内平均动脉压和脉压差分别为 (16.89± 0 .2 4)、(4 .45± 1.3 0 )kPa ,术后分别为 (5 .5 5± 0 .13 )、(0 .0 7± 0 .0 1)kPa ,均明显下降 (P <0 .0 1) ;而实验组瘤腔内术前平均动脉压和脉压差分别为 (17.11± 0 .2 6)、(4 .65± 1.5 7)kPa ,在内漏状态下分别为 (18.0 9± 0 .3 4)、(4 .12± 0 .3 7)kPa ,无明显变化 (P >0 .0 5 ) ;瘤腔内注射纤维蛋白胶后血管造影示内漏消失 ,此时瘤腔内平均动脉压和脉压差分别为 (2 0 .2 2± 0 .3 2 )、(1.19± 0 .13 )kPa ,即压力不会立即下降 ,但脉压差会显著下降 (P <0 .0 1) ,且压力曲线基本接近一条直线。结论 瘤腔内压力可以作为判定腔内隔绝术成功与否的标准之一 ,也可以作为术中判断内漏存在的指标之一。采用经动脉插管到瘤腔内或者瘤壁直接穿刺注射促凝血药物治疗术中内漏可行。

ObjectiveTo explore the disposal of the completion endoleak of endovascular exclusion (EVE).MethodsInfrarenal aortic aneurysms were created with bovine jugular vein segments or patches.Then they were subjected to EVE of the aneurysm.After modification of prosthetic vessel and changing the attachment site,endoleaks were formed during exclusion.The fibrin glue was injected into the excluded sac to seal completion endoleak.The intrasac pressure was measured during the operation with and without endoleak.ResultsIn the control group,the intrasac mean pressure (MP) changed from (16.89±0.24) kPa before EVE to (5.55±0.13) kPa after EVE,which was decreased significantly ( P <0.01).But the intrasac MP in the presence of endoleak was (17.11±0.26) kPa,which had no significant difference from that of aneurysm pre-operation ( P >0.05).After the endoleak was sealed with coagulation medication,the change of MP had no difference,but (SP-DP) which changed from (4.12±0.37) kPa to (1.19±0.13) kPa had significant difference ( P <0.01).And the pressure curve was approximately linear.ConclusionThe change of intra-aneurysmal pressure wave reflected the load of aneurismal wall after EVE,and can also help to determine the endoleak.It was feasible to seal the completion endoleak by injection of coagulation medication into incompletely excluded aneurysm sac.