颈动脉内膜切除手术技巧及围手术期处理：多中心临床经验总结

目的 总结国内外多中心3 226例次颈动脉内膜切除术（CEA）治疗颅外段颈动脉粥样硬化狭窄手术技巧及围手术期处理.方法 回顾分析2005年5月至2013年5月国内外多中心收治的3 012例颈动脉狭窄患者,共完成CEA 3 226例次,总结围术期处理经验,探讨手术方式及操作技巧.结果 3 226例次CEA手术均成功,2 910例（90.2％）行外翻式CEA （EEA）,316例（9.8％）行补片式CEA （pCEA）,平均阻断时间（15.5±2.0） min,平均手术时间（50.5 ±5.0） min.112例使用沿皮纹横切口.围术期死亡3例,脑梗死2例,同侧脑出血1例,切口血肿28例,1例术后出现严重神经精神症状,认知障碍,1例发生下颌小关节脱位,术后代偿;脑神经损伤6例,其中舌下神经损伤4例,面神经下颌支损伤2例.81例高危因素患者CEA手术成功,术后均无严重并发症及死亡发生.结论 CEA是治疗颈动脉狭窄预防卒中安全、有效的方法,完善的围手术期管理及“4S＋1D”原则是CEA成功的关键.EEA操作简捷、手术及阻断时间短,无需补片及转流管,费用低廉,值得推广.

Fracture of a cerebral protection device wire in carotid artery stenting： an unexpected complication

There are very few reports concerning the failure of devices used in carotid artery stenting. Here we report a fracture of the distal part of the guiding wire of a cerebral protection device during carotid artery stenting for management of a restenotic lesion after carotid endarterectomy.

Delayed type lllb endoleak using Anaconda^TM stent graft in abdominal aortic aneurysm repair

Endoleaks are defined as the persistence of blood flow outside the lumen of the endoluminal graft but within an aneurysm sac or the adjacent vascular segment being treated by the graft and classified into 5 categories.