腹主动脉瘤的相关危险因素及诊疗进展

Risk Factors Associated with Abdominal Aortic Aneurysm and Advances in Treatment

腹主动脉瘤(Abdominal aortic aneurysm, AAA)是最常见的动脉瘤之一,病变位置通常发生在肾脏下腹主动脉。AAA的诊断需结合临床症状和体征,关键是要利用影像学检查对动脉直径进行测量以综合判断。SVS、ESVS以及NICE3项指南均将腹主动脉瘤体直径 ≥ 3 cm作为AAA的诊断标准,并且均建议采用多普勒超声作为AAA筛查的首选方法,这一建议得到多数证据的支持。大多数患有这种疾病的患者在早期阶段没有明显的症状,也不会在短期内对患者造成严重后果。一旦破裂,它可能会导致严重出血、严重腹痛、低血压和其他症状,甚至导致死亡。目前,手术是主要的治疗方法。与传统的开腹手术相比,腹主动脉瘤腔内修复术(Endovascular aneurysm repair, EVER)修复因其轻微创伤、快速恢复、术后并发症和低死亡率而被广泛使用和认可。在此基础上,还拓宽了手术指征,使大量AAA病人得到及时救治。国内EVAR技术日趋成熟,逐渐向国际水平看齐,并且近年来国内各中心报告的EVAR预后也在稳步提升。使某些不宜行开放手术的患者也得到了有效的治疗。本文通过总结有关腹主动脉瘤腔内修复术的文章进行综述。

Abdominal aortic aneurysm (AAA) is one of the most common aneurysms, usually located in the lower abdominal aorta of the kidney. The diagnosis of AAA needs to be combined with clinical symptoms and signs, and the key is to use imaging examinations to measure the artery diameter for comprehensive judgment. The SVS, ESVS, and NICE guidelines all use abdominal aortic aneurysm diameter ≥ 3 cm as the diagnostic criteria for AAA, and all recommend using Doppler ultrasound as the preferred method for AAA screening, which is supported by most evidence. Most patients with this disease have no obvious symptoms at an early stage and will not have serious consequences for the patient in the short term. Once ruptured, it can cause severe bleeding, severe abdominal pain, hypotension, and other symptoms, even leading to death. Currently, surgery is the main treatment. Compared with traditional open surgery, abdominal aortic aneurysm endovascular repair (EVER) is widely used and recognized for its mild trauma, rapid recovery, postoperative complications, and low mortality. On this basis, the surgical indications have also been broadened, enabling a large number of AAA patients to receive timely treatment. The domestic EVAR technology is becoming increasingly mature, gradually aligning with the international level, and in recent years, the prog-nosis of EVAR reported by domestic centers has also been steadily improving. Some patients who are not suitable for open surgery have also received effective treatment. This article summarizes the articles on endovascular repair of abdominal aortic aneurysm.