Transarterial Embolization versus Translumber Embolization for Type Ⅱ Endoleak after Endovascular Abdomi nal Aortic Aneurysm Repair:A Meta-Analysis

Objective Type II endoleak is the most common subtype of endoleak as a complication after endovascular aneurysm repair(EVAR).The efficacy of transarterial(TA)embolization and translumber(TL)embolization in the management of type II endoleak remains equipoise.The aim of this study is to compare the technical and clinical success between TA embolization andTL embolization for type II endoleak after EVAR.Methods The protocol was registered(CRD 42018114453)and the electronic databases(Pubmed,Embase,Web of Science,and Cochrane)were systematically searched till March 2019.The search terms included EVAR,type II endoleak,and embolization.The articles were read and extracted by two authors independently to include randomized control trails and retrospective studies that compared TA embolization and TL embolization in patients who developed type II endoleak after EVAR.The technical and clinical success rates were metaanalyzed with random effect model.Results A total of 6 articles with 268 patients and 290 type II endoleaks were included.The pooled odds ratio(OR)of technical success rate for TA vs.TL was 0.56(95%C7,0.10-3.18;P=0.51)and the pooled OR of clinical success rate for TA vs.TL was 0.31(95%CI,0.07-1.29;P=0.11).As a limitation,6 articles were all retrospective studies which may lead to bias.Conclusion Both TA.andTL could be eflective procedure of embolizations to resolve the type II endoleak.The metaanalysis result indicated that TA embolization was not inferior toTL embolization in technical success and clinical success.

Endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases using Willis covered stent

Background:To report the clinical results and experiences of endoleak management and postoperative surveillance following endovascular repair of internal carotid artery vascular diseases(ICAVDs)using Willis covered stents.METHODS:Seventy-three patients with ICAVD who received Willis covered stent implantation between November 2013 and September 2018 were retrospectively reviewed.The clinical data of endoleak management and postoperative surveillance were analyzed.RESULTS:Seventy-three cases with ICAVD,including 57 aneurysms,11 carotid-cavernous sinus fistulas(CCF),and 5 surgical injuries,were all successfully installed with covered stents.Total isolation of ICAVDs was achieved in 59 patients(80.8%),and endoleaks were observed in 14 patients(19.2%).Of the 14 patients with endoleaks,12 had type I endoleaks and 2 had type II;13 had aneurysms and one had CCF.10 patients with type I endoleaks received balloon dilatation,and 7 of them underwent a second stent-graft implantation after then.One patient with type II endoleak received embolization of the branch artery,and another one received follow-up observation.Endoleaks resolved in 6 patients and were minimal in 5 patients after balloon dilatation or the second stent implantation.During the follow-up period,minor endoleaks spontaneously resolved in 4 patients and minimal endoleaks were still demonstrated in 4 patients without enlargement of residual lumen and rupture.CONCLUSIONS:Endoleaks are the major complication after endovascular repair of ICAVDs and represent one of the limitations of this procedure.Improving the understanding and management of endoleaks can be beneficial in the clinical setting,including the popularization and application of this technique.

Rupture of an Infrarenal Aortic Aneurysm Due to a Secondary Type 1a Endoleak Following Endovascular Aneurysm Sealing with the Nellix^®Device

Purpose: The Nellix endovascular aneurysm sealing (EVAS) system was introduced in 2010 for infrarenal abdominal aortic aneurysm (AAA) repair. So far one secondary type 1a endoleak resulting in rupture of the aneurysm has been reported. Case report: We present a case of a rupture of an infrarenal aortic aneurysm due to a secondary type 1a endoleak caused by stent migration 14 months after endovascular aneurysm sealing with a Nellix system. Conclusion: Strict adherence to anatomical requirements given by the instructions for use during patient selection and thorough post interventional surveillance may reduce the probability of secondary type 1a endoleaks. Furthermore, device design changes, especially concerning the configuration of the proximal part of the stent graft, have to be considered.

经股动脉逆向支架外栓塞补救腹主动脉腔内修复术中内漏的单中心经验

目的探索腹主动脉腔内修复术(endovascular aortic repair,EVAR)中经股动脉逆向支架外瘤腔内栓塞内漏的有效性和安全性。方法回顾性分析2021年12月至2023年10月首都医科大学附属北京友谊医院11例EVAR术中经股动脉逆向瘤腔内栓塞补救内漏的患者临床资料,其中包括8例Ⅰ型内漏和3例Ⅱ型内漏。内漏均通过瘤腔内弹簧圈栓塞或联合液体栓塞剂处理,并在随访期间定期接受CT血管造影(computed tomography angiography,CTA)随访。结果9例单纯使用弹簧圈栓塞,2例使用弹簧圈辅助生物蛋白胶及凝血酶散栓塞,造影见8例内漏完全消失、3例内漏明显减少。术中1例出现生物蛋白胶异位栓塞,其余患者无相关并发症发生。术后随访6~24个月,平均随访时间(10.4±5.4)个月,CTA复查结果显示无明确内漏发生,6例瘤体直径较前减小,5例直径无变化,随访期间无再次手术及死亡发生。结论经股动脉逆向支架外栓塞可补救EVAR术中Ⅰ型或Ⅱ型内漏,短期疗效满意。

腹主动脉瘤腔内修复术后Ⅱ型内漏的防治进展

Ⅱ型内漏是腹主动脉瘤腔内修复术(EVAR)后的常见并发症,对EVAR手术患者的预后有较大的影响。预防Ⅱ型内漏的方法主要是在术中置入支架之前进行瘤囊分支动脉的栓塞,或置入支架后使用Onyx胶或其他特殊材料进行瘤囊的填充。治疗方法有保守治疗、栓塞治疗(经动脉途径、经腰途径、经腔静脉途径)、腹腔镜下动脉结扎手术、开放手术等,在临床上应用较多的是经动脉途径和经腰途径栓塞治疗。关于Ⅱ型内漏的预防、治疗方法,目前暂无统一标准。该文对近年来Ⅱ型内漏预防、治疗方面研究进展进行综述,以期为临床医生的临床决策提供参考。

Contrast-enhanced Ultrasound in Detecting Endoleaks with Failed Computed Tomography Angiography Diagnosis after Endovascular Abdominal Aortic Aneurysm Repair

Background： Endovascular aneurysnl repair （EVAR） is one of the first-line therapies of abdominal aortic aneurysms. Postoperative endoleak is the most common complication of EVAR. Computed tomography angiography （CTA）, which is routine for follow-up, has side effects （e.g., radiation） and also has a certain percentage of missed diagnosis. Preliminary studies on contrast-enhanced ultrasound （CEUS） have shown that the sensitivity of CEUS for detecting endoleak is no lower than that of CTA. To investigate the advantages of CEUS, we conducted CEUS examinations of post-EVAR cases in which CTA failed to detect endoleak or could not verify the type of endoleak. Methods： Post-EVAR patients, who were clinically considered to have endoleak and met the inclusion criteria were enrolled between March 2013 and November 2014. All of the patients underwent color Doppler flow imaging （CDFI） and a CEUS examination. Size, location, microbubble dispersion, and hemodynamic characteristics of leaks were recorded. Comparison between the diagnosis of CEUS and CDF1 was conducted using Fisher＇s exact test and clinical outcomes of all patients were followed up. Results： Sixteen patients were enrolled, and 12 （75%） had endoleaks with verified types by CEUS. Among 12 cases of endoleaks were positive by CEUS, 10 were CDFl-positive, and the four CEUS-negative cases were all negative by CDFI. The diagnostic values of CEUS and CDFI were statistically difl＇erent （P = 0,008）. Six patients with high-pressure endoleaks received endovascular re-intervention guided by CEUS results. One patient with type Ⅲ endoleak had open surgery when endovascular repair failed. Conclusions： C EUS is a new, safe, and effective means for detection ofendoleaks post-EVAR. This technique can be used as a supplement for routine CTA follow-up to provide more detailed information on endoleak and its category.

腹主动脉瘤腔内修复术后Ⅱ型内漏的影响因素分析

目的探讨腹主动脉瘤(AAA)瘤腔内血栓形态与腹主动脉瘤腔内修复术(EVAR)后发生Ⅱ型内漏的关系。方法收集2018年1月至2022年6月于滨州市第二人民医院和山东第一医科大学附属省立医院接受EVAR治疗的182例AAA患者的临床资料和影像学资料,根据随访期内是否发生Ⅱ型内漏将患者分为Ⅱ型内漏组(n=44)和对照组(n=138)。比较两组患者的临床特征、血液指标、计算机断层扫描血管成像(CTA)影像学特征,筛选EVAR术后发生Ⅱ型内漏的影响因素,建立预测模型并绘制列线图,并通过绘制模型的校准曲线、受试者工作特征(ROC)曲线和临床决策曲线验证预测模型的准确性。结果两组患者的高血压病史、吸烟史、最大横截面血栓厚度、最大横截面血栓面积、血栓体积、最大瘤体直径和腰动脉数量比较,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,最大横截面血栓厚度厚、最大横截面血栓面积大、血栓体积大均是EVAR术后发生Ⅱ型内漏的保护因素,腰动脉数量多是EVAR术后发生Ⅱ型内漏的危险因素(P﹤0.05)。模型的ROC曲线下面积为0.901。校准曲线显示模型预测曲线与预期曲线重合性较好。临床决策曲线显示,若截断值为4%~98%,则模型的临床有效性较好。结论最大横截面血栓厚度、最大横截面血栓面积、血栓体积和腰动脉数量均是EVAR术后发生Ⅱ型内漏的影响因素,据此构建的预测模型准确性较高,可用于预测EVAR术后Ⅱ型内漏的发生风险。

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.

Management of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair

We reported a case of multiple type II endoleaks detected by duplex ultrasound after endovascular abdominal aneurysm repair. The patient was undergoing warfarin therapy. Duplex ultrasound was applied as the sole surveillance method during follow-up and provided the concerned information for reintervention. The endoleaks were successfully repaired by coil embolization of the collaterals from the internal lilac artery feeding the fourth lumbar artery.

直视降主动脉支架治疗主动脉弓部破口的急性B型主动脉夹层效果分析

目的探讨直视降主动脉支架治疗主动脉弓部破口的急性B型主动脉夹层(ABAD)的效果。方法选取2021年6月至2022年9月首都医科大学附属北京安贞医院收治的18例破口位于主动脉弓部的ABAD患者,均接受直视降主动脉支架治疗。所有患者的内膜撕裂口均位于无名动脉和左锁骨下动脉之间。记录所有患者的临床表现、术中资料、术后资料和随访结果并进行分析。结果所有患者均成功闭合了原发性弓部破口。同期心脏手术3例(16.7%),包括主动脉瓣置换术1例,冠状动脉旁路移植术2例。手术时间(325±56)min,体外循环时间、主动脉阻断时间和选择性脑灌注时间分别为(145±23)、(58±20)、(24±5)min。呼吸机使用时间(15±5)h,住监护室时间(38±24)h,术后住院天数(12±5)d。术后无死亡、脊髓损伤、Ⅰa型内漏和逆行A型主动脉夹层。1例患者术后发生非致残性脑梗死,1例术前慢性肾功能不全的患者术后接受连续性肾脏替代治疗2周。随访时间为(10±4)个月,1例患者在术后6个月接受胸腹主动脉置换术。支架周围假腔血栓化18例(100.0%),膈肌水平假腔血栓化11例(61.1%),腹腔干水平假腔血栓化6例(33.3%)。结论直视降主动脉支架治疗破口位于主动脉弓部的ABAD是安全、有效的。它保留了弓部头臂血管及升主动脉。使用该技术,没有发生Ⅰa型内漏和逆行A型主动脉夹层的风险。此外,术中支架植入也有利于二期胸腹主动脉置换手术的实施。

腹主动脉瘤腔内修复术后Ⅱ型内漏相关再干预的危险因素分析

目的探讨腹主动脉瘤(AAA)患者腔内修复术(EVAR)后Ⅱ型内漏(T2EL)相关再干预的危险因素及危险阈值。方法收集2015年1月至2021年12月于内蒙古医科大学附属医院进行EVAR的97例AAA患者的临床资料,根据是否进行了术后T2EL相关再干预将患者分为再干预组(n=14)和非再干预组(n=83)。比较两组患者的临床特征。分析两组患者AAA的形态学特征,确定T2EL的发生情况。分析AAA患者EVAR术后T2EL相关再干预的危险因素并确定其危险阈值,进而评估AAA患者EVAR术后T2EL相关再干预的风险。结果再干预组患者的吸烟比例、高血压比例均高于非再干预组患者(P﹤0.05)。再干预组患者的瘤体最大直径、肠系膜下动脉(IMA)直径、腰动脉(LA)数量均明显大于非再干预组患者(P﹤0.01)。多因素分析结果显示,瘤体最大直径、IMA直径、LA数量均是AAA患者EVAR术后T2EL相关再干预的独立危险因素(P﹤0.05)。受试者工作特征(ROC)曲线分析结果显示,瘤体最大直径≥56.85 mm、IMA直径≥2.95 mm的AAA患者在EVAR术后因T2EL而再次干预的风险较高。结论具有危险因素的AAA患者EVAR术后T2EL相关再干预的可能性较高,而高于IMA直径和瘤体最大直径风险阈值的AAA患者EVAR术后T2EL相关再干预的可能性更高。

Safety and Efficacy of Endovascular Aortic Repair for Abdominal Aortic Aneurysms with a Hostile Neck Anatomy

Objective This study aimed to investigate the safety and efficacy of endovascular aortic repair(EVAR)for the treatment of an abdominal aortic aneurysm(AAA)with a hostile neck anatomy(HNA).Methods From January 1,2015 to December 31,2019,a total of 259 patients diagnosed with an AAA who underwent EVAR were recruited into this study.Based on the morphological characteristics of the proximal neck anatomy,the patients were divided into the HNA group and the friendly neck anatomy(FNA)group.The patients were followed up for up to 4 years.Results The average follow-up time was 1056.1±535.5 days.Type I endoleak occurred in 4 patients in the HNA group,and 2 patients in the FNA group.Neither death nor intraoperative switch to open repair occurred in either group.The time of the operation was significantly longer in the HNA group(FNA vs.HNA,99.2±51.1 min vs.117.5±63.8 min,P=0.011).There were no significant differences in short-term clinical success rate(P=0.228)or midterm clinical success rate(P=0.889)between the two groups.The overall mortality rate was 10.4%,and Kaplan-Meier survival analysis indicated that the two groups had similar cumulative survival rates at the end of the follow-up period(P=0.889).Conclusion EVAR was feasible and safe in patients with an AAA with a proximal HNA.The early and midterm results were promising;however,further studies are needed to verify the long-term effectiveness of EVAR.

Efficacy of Willis covered stent of intracranial pseudoaneurysms in the internal carotid artery: A systematic review and meta-analysis

Objective:To evaluate the efficacy of a novel coated stent in the treatment of intracranial pseudoaneurysm.Methods:MEDLINE,EMBASE,and PubMed databases were searched for literature published between 1990 and April 2022 according to PRISMA guidelines.All studies with≥10 patients reporting successful implantation of Willis covered stent,therapeutic effect,complications,and postoperative follow-up were included.The combined incidence and corresponding 95%confidence intervals were assessed using a generalized linear mixed method and random effects model.Results:Five studies(116 patients with pseudoaneurysms)were included.The experimental groups in the selected studies showed a combined technical success rate of 81.03%(OR=18.31,95%CI=9.39-35.69,I^(2)=79%,P<0.001).Clinical follow-up showed that the complete cure rate was as high as 94.4%after the follow-up(OR=106.81,95%CI=39.08-291.88,I^(2)=0%,P=0.71).Conclusions:Willis covered stent is feasible,safe,and effective in the treatment of intracranial pseudoaneurysm.

腹主动脉瘤腔内修复术后内漏的发生及转归:单中心10年随访结果分析

目的研究腹主动脉瘤(abdominal aortic aneurysm,AAA)患者行腹主动脉腔内修复术(endovascular aortic repair,EVAR)后内漏的发生情况及转归的趋势与规律。方法回顾性收集中山大学附属第一医院2013~2022年195例行常规EVAR术及EVAR+烟囱技术重建内脏动脉(chimney endovascular aortic repair,Ch-EVAR)后发生内漏的真性AAA患者临床资料,比较各型内漏的发生率,比较不同处理方式对内漏的预后有无影响。结果Ch-EVAR术后内漏发生率显著高于常规EVAR(46.4%vs 23.0%,P<0.001)。Ⅰa型、Ⅰb型、Ⅱ型、Ⅲ型和Ⅳ型内漏的发生率分别为13.3%、2.8%、5.5%、2.3%和1.8%。病例平均随访(35.5±25.8)个月,各型内漏在随访期内消失的比例分别为63.3%、73.9%、51.1%、57.9%和73.3%,经干预后内漏的转归与未干预内漏相比差异均无统计学意义(P均>0.05)。EVAR术后30d内死亡4例,其中1例为术后动脉瘤破裂;术后30d后死亡40例,其中4例与内漏相关。结论针对不同类型的内漏采取不同的处理方式,对瘤体持续增大和/或患者有症状的内漏进行积极干预,均能取得较为满意的结果。

彩色多普勒超声在腹主动脉瘤腔内修复术后内漏中的临床应用价值

目的:对比分析CT血管造影(CTA)与彩色多普勒超声(CDUS)在腹主动脉瘤腔内修复术(EVAR)术后内漏中的临床应用,评估CDUS在EVAR术后内漏中的应用价值。方法:对2017年1月—2022年3月郑州大学第五附属医院收治的40例进行EVAR治疗的腹主动脉瘤患者进行回顾性分析,计算并比较两种方式检查术后内漏的检出率,对内漏的检出结果进行一致性比较。结果:40例EVAR术后第1个月CDUS检出内漏有13例;CTA检查结果显示内漏11例。CDUS及CTA对于腹主动脉瘤腔内修复术后内漏的检出率分别为32.5%、27.5%,Mc Nemar检验计算P=0.688,CDUS对于内漏的检出率高于CTA,但是两种检查方式差异无统计学意义(P> 0.05),k值为0.644,二者的一致性较好;CDUS比CTA多发现的2例均为EVAR术中使用瘤腔弹簧圈栓塞患者;由CDUS更正诊断内漏分型1例。结论:CDUS在EVAR术后内漏诊断中具有较高的应用价值,具有安全便捷、无辐射、可重复等优势,可作为EVAR术后随访的重要检查方法。

腹主动脉瘤腔内修复术后瘤体直径及体积变化的随访研究

目的探讨腹主动脉瘤腔内修复术后瘤体直径和瘤体体积的转归以及与术后内漏的关系。方法回顾性分析2015年-2020年在我院行腹主动脉瘤腔内修复术的83例患者的临床及影像学资料。测量术前和术后各随访时间点瘤体最大直径及体积。CT评价术后内漏发生情况。定义瘤体(直径/体积)扩张/回缩及瘤体(直径/体积)稳定。以术前瘤体最大直径大小和术后内漏发生情况将患者分组,比较组间各随访时点的瘤体直径和体积转归情况。结果患者术后平均随访时间24(10~62)个月。以瘤体直径<50 mm及≥50 mm分组,术后各随访时间点2组间瘤体体积及瘤体直径比较均无统计学差异。以术后有无内漏分组,术后各随访时间点组间比较瘤体体积变化比较差异均有统计学意义(P<0.05),但瘤体直径变化组间比较差异均无统计学意义。结论主动脉瘤瘤体体积与直径变化并不存在一致性,监测瘤体体积可以发现那些直径变化不明显的瘤体变化;腹主动脉瘤腔内修复术后内漏可能是导致瘤体增大的因素之一。

腹主动脉瘤腔内修复术后Ⅱ型内漏的影响因素分析和预测模型构建

目的探讨腹主动脉瘤(AAA)腔内修复术(EVAR)后发生Ⅱ型内漏的影响因素并构建预测模型。方法收集2018年1月至2022年9月于山东第一医科大学附属省立医院进行EVAR治疗的286例AAA患者的临床资料,根据术后随访期间是否发生Ⅱ型内漏将患者分为对照组(n=210)和Ⅱ型内漏组(n=76)。比较两组患者的临床特征、血液指标、AAA解剖情况及手术情况。分析AAA患者EVAR术后发生Ⅱ型内漏的影响因素,构建预测模型,绘制列线图,构建评分系统,并绘制模型的校准曲线,计算一致性指数(C-index),绘制受试者工作特征(ROC)曲线和临床决策曲线,验证预测模型的准确性和临床有效性。结果两组患者的吸烟史比例、肠系膜下动脉(IMA)开口直径、腰动脉(LA)数量和IMA通畅情况比较,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,吸烟史是AAA患者EVAR术后发生Ⅱ型内漏的保护因素,IMA通畅情况、IMA开口直径和LA数量均是AAA患者EVAR术后发生Ⅱ型内漏的独立危险因素(P﹤0.05)。预测模型的C-index为0.824(95%CI:0.718~0.930),校准后的C-index为0.812(95%CI:0.710~0.914)。ROC曲线下面积为0.824;模型校准曲线显示模型预测曲线与预期曲线的重合性较好;临床决策曲线表明,若截断值为7%~99%,则该模型的临床有效性较好。结论吸烟史、IMA通畅情况、IMA开口直径和LA数量均是AAA患者EVAR术后发生Ⅱ型内漏的影响因素,根据各个影响因素所构建的预测模型的准确性较好,可用于预测AAA患者EVAR术后Ⅱ型内漏的发生风险。

腔内隔绝术治疗高风险腹主动脉瘤

目的评价腔内隔绝术治疗外科高风险腹主动脉瘤(AAA)的疗效及安全性。方法51例AAA患者行腔内隔绝术。按国际血管外科/心血管外科(SVS/ISCVS)手术风险评估方法分级,1级(较低风险)30例,2～3级(高风险)21例。根据术前CT及DSA资料合理选择支架。术后定期临床及CT影像随访,观察并发症及瘤体形态学变化。结果覆膜支架均顺利置入,技术成功率100%,术中及术后30 d无死亡。所有患者术后平均随访(29.1±20.5)个月,死亡1例(术后36 d),死因不详。主要并发症5例(9.8%),包括分支支架内血栓形成2例,股动脉切口局部并发症2例(血栓形成及淋巴管瘘),支架单臂脱位导致内漏增多1例。术后少量内漏10例(19.6%),其中5例随访期自行消失。结论腔内隔绝术治疗AAA,特别是外科高风险患者,近中期疗效满意。

胸主动脉夹层动脉瘤腔内隔绝术后内漏的评估

32例StanfordB型胸主动脉夹层动脉瘤患者接受了腔内隔绝术 ,术中发现内漏 4例 ,即时腔内方式治愈 3例 ,自愈 1例 ;术后迟发型内漏 1例。内漏的发生与多种因素有关 ,术中DSA及术后螺旋CT是发现内漏的有效方法 ;发生内漏后主张尽快以腔内方式治疗 ;小量内漏可自愈 ;

复杂腹主动脉瘤腔内修复65例经验

目的探讨复杂肾下腹主动脉瘤腔内治疗的结果。方法回顾性分析2006年1月~2013年3月65例复杂肾下腹主动脉瘤腔内治疗的资料。其中腹主动脉瘤颈过短（〈2 cm）15例（23.1%）,参照肾动脉将支架向腹主动脉近侧释放;瘤颈严重成角（≥60°）28例（43.1%）,将腹主动脉拉直再释放支架;同时具有短瘤颈和严重成角10例（15.4%）;涉及双髂总动脉瘤的保留髂内动脉的处理5例（7.7%）,尽量保留一侧髂内动脉以防盆腔脏器缺血,2例分期行髂内动脉覆盖;入路动脉狭窄或者闭塞导致腔内覆膜支架的输送器到达预定位置困难5例（7.7%）;合并其他特殊病变2例（3.1%）。均采用腔内覆膜支架修复,其中进口血管支架29例（44.6%）,国产血管支架36例（55.4%）。结果手术均成功。23例（35.4%）即时内漏,其中Ⅰ型6例,Ⅱ型14例,Ⅲ型3例。无手术死亡。术后住院时间7~15 d,平均8.2 d。随访60例（92.3%）,随访时间1~8年,平均3.5年。死亡5例（8.3%）,死亡原因均与该病无关。1例半年后支架移位,内漏,再次行腔内修复,置延长段支架后内漏消失,继续随访22个月,支架形态和位置良好,无支架移位和内漏发生。其他内漏均消失。左下肢缺血3例,原因为1例左侧髂分支支架移位导致闭塞,行股-股动脉耻骨上人工血管旁路移植后下肢缺血症状缓解,2例髂动脉打折,再次腔内治疗放置裸支架后缺血症状缓解。结论随着腔内技术的发展和腔内治疗器材的不断完善,过去认为不能采用腔内治疗的复杂腹主动脉瘤也可以采用腔内治疗,对于复杂肾下腹主动脉瘤,腔内治疗可以获得较为满意的中远期疗效。