Endovascular technique using a snare and suture for retrieving a migrated peripherally inserted central catheter in the left pulmonary artery

We report a successful endovascular technique using a snare with a suture for retrieving a migrated broken peripherally inserted central catheter(PICC)in a chemotherapy patient.A 62-year-old male received monthly chemotherapy through a central venous port implanted into his right subclavian area.The patient completed chemotherapy without complications 1 mo ago;however,he experienced pain in the right subclavian area during his last chemotherapy session.Computed tomography on that day showed migration of a broken PICC in his left pulmonary artery,for which the patient was admitted to our hospital.We attempted to retrieve the ectopic PICC through the right jugular vein using a gooseneck snare,but were unsuccessful because the catheter was lodged in the pulmonary artery wall.Therefore,a second attempt was made through the right femoral vein using a snare with triple loops,but we could not grasp the migrated PICC.Finally,a string was tied to thetop of the snare,allowing us to curve the snare toward the pulmonary artery by pulling the string.Finally,the catheter body was grasped and retrieved.The endovascular suture technique is occasionally extremely useful and should be considered by interventional cardiologists for retrieving migrated catheters.

Comparison of Clinical Effects of Abdominal Aortic Aneurysm Treatment with Open and Endovascular Techniques

Objective:To compare the therapeutic effects of endovascular and open surgery on abdominal aortic aneurysms.Methods:From June 2019 to May 2020,60 cases of abdominal aortic aneurysms(AAA)were divided into observation group(30 cases in endovascular technique group)and control group(30 cases in open technique group).Results:The blood loss,operative time and blood transfusion of the observation group were significantly lower than those of the control group(P<0.05).The incidence of postoperative complications is low,and the incidence of longterm complications is relatively high.Conclusion:In the treatment of abdominal aortic aneurysm,endovascular technology has the advantages of low risk,less trauma,and quick recovery after surgery.Open surgery is suitable for patients who cannot receive endovascular treatment.In order to achieve good treatment effects,it is necessary to choose an appropriate treatment method according to the actual situation of the patient.

Application Effects of Total Percutaneous Technique in Endovascular Repair of Abdominal Aortic Aneurysm

Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received conventional treatment,and the experimental group received modified treatment.The changes in self-management ability,comfort level and recovery time before and after treatment were compared between the two groups.Results:The comfort level and self-management ability of the experimental group were significantly higher than that of the control group,and the recovery time was significantly shorter than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Puncture suture can safely and effectively repair the intracavity of abdominal aortic aneurysm.

Short-term results in canines of novel stent-graft design for chimney technique in TEVAR

Introduction:Parallel stent-stent grafting is a major endovascular technique used to preserve the supra-aortic branches during thoracic endovascular aortic repair(TEVAR)of aortic pathologies involving the aortic arch.The short-and mid-term results of this technique are satisfactory;however,endoleak remains a major concern.Thus,here we designed a new chimney stent-graft to decrease the endoleak rate.Aim:To testify the feasibility and safety of the new chimney stent-graft system in a canine model.Material and methods:Six Labrador retrievers were used.Pre-operative data were collected and all operations were performed under general anesthesia.The main and chimney stent-grafts were implanted through the abdominal aorta and left subclavian artery approaches,respectively.Completion digital subtraction angiography(DSA)was performed to confirm the immediate outcomes.All dogs were fed separately for 6 months and sacrificed after aortic angiography.The thoracic aorta and the main and chimney stent-grafts were harvested for histopathologic examination.Results:No complications were found in follow-up DSA.All branch arteries were patent.In?ammatory responses were observed around the stent-grafts in 3 experimental animals,and slight hyperplasia was observed in the surrounding tissues compared with the normal vessels.There was no mural thrombus in the stent,endothelial cells were noted on the inner surface of the stent,and thrombus was formed in the outer skirt and gutter area.The histopathologic examinations revealed similar results to those of gross necropsy observations.Conclusions:This study demonstrated the feasibility and safety of the Longuette stent-graft and the first to report a revised stent-graft specific for chimney technique.

下肢动脉硬化闭塞症腔内治疗中逆穿技术的应用效果及影响因素分析

目的 探讨下肢动脉硬化闭塞症腔内治疗中逆穿技术的应用效果及其影响因素。方法 选取实施腔内治疗的70例下肢动脉硬化闭塞症患者,实施逆穿技术的35例患者为逆穿组,未实施逆穿技术的35例患者为对照组,统计逆穿组患者手术前后患肢踝肱压力指数、患侧足部温度、间歇性跛行距离和术后并发症发生率,对比两组患者性别、年龄等资料,筛选影响逆穿技术实施的因素,绘制受试者工作特征曲线并计算曲线下面积评价影响因素的预测效能。结果 逆穿组患者术后踝肱压力指数、患侧足部温度和间歇性跛行距离较术前明显提高,差异有统计学意义(P<0.05);闭塞管腔近心端斑块面积和斑块负荷是影响逆穿技术实施的影响因素。结论 逆穿技术是下肢动脉硬化闭塞症腔内治疗中的重要手段,可有效改善下肢血液供应;医师术前可通过测量闭塞管腔近心端斑块面积和斑块负荷预估术中逆穿技术的实施概率并制定手术方案。

导丝会师技术在腋动脉损伤腔内治疗中的临床应用

目的探讨导丝会师技术在腋动脉损伤腔内治疗中的应用价值。方法回顾性分析2008年1月—2020年8月解放军第九六〇医院收治的腋动脉损伤患者22例,男性16例,女性6例;年龄30~66岁,平均40.3岁。经股动脉及患侧桡动脉入路,双向入路导丝会师腋动脉损伤段,经股动脉引入圈套器,将导丝拉出体外,建立股-桡动脉的“体外导丝”工作轨道,然后行支架植入术。观察患者围术期情况、治疗效果、手术并发症及再干预情况等。结果腔内治疗过程中采用导丝会师技术成功率100%,共植入支架34枚,平均1.5枚,术中造影示腋动脉血流完全恢复通畅。随访6~49个月,平均28.6个月,支架内血流通畅或支架腔内狭窄小于30%未行腔内干预20例,支架腔内狭窄超过50%再次腔内治疗2例,无支架移位、断裂、内瘘等。结论腋动脉损伤腔内治疗过程中采用导丝会师技术成功率高,术后并发症少,临床效果满意,应用价值大。

腔内介入技术对透析患者血管通路问题的临床应用

目的:探讨腔内介入技术对透析患者血管通路问题的临床应用效果。方法:选择2020年10月—2022年1月新余市人民医院收治的60例由于血管通路问题无法顺利进行透析治疗的终末期肾脏病(ESRD)患者作为研究对象,60例透析的ESRD患者均行腔内介入技术治疗,包括超声引导下动静脉内瘘球囊扩张术或减影血管造影(DSA)下中心静脉球囊扩张术+支架植入术。统计入选的ESRD患者腔内介入技术治疗后通路开通率,比较其术前、术后肱动脉血流量、血管阻力指数(RI),统计其术后KT/V值(在一定透析时间内透析器对尿素的清除量与体积的比值),统计其术后随访3个月腔内介入技术治疗后远期开放率。结果:60例患者中,采用腔内介入技术治疗后57例患者恢复正常透析,保留血管通路,血管通路开通率为95.00%(57/60)。患者术后的肱动脉血流量高于术前,RI低于术前,差异有统计学意义(t=26.886、15.908,P<0.05)。患者术后的KT/V值为(1.33±0.40),透析充分。术后随访3个月,患者腔内介入技术治疗远期开放率为91.66%(55/60)。结论:腔内介入技术能够解决透析患者的血管通路问题,保证血管通路通畅,提高肱动脉流量,保证透析充分性。

Rapid hemostasis of the residual inguinal access sites during endovascular procedures:A case report

BACKGROUND In endovascular procedures including total percutaneous endovascular aneurysm repair(pEVAR),percutaneous access through the common femoral artery is most commonly performed.Access-site bleeding is a major concern in percutaneous techniques.Herein,we present a case of successful control of continuous oozing using a vascular closure device(VCD)and the application of Surgicel(Johnson&Johnson,United States)over the access tract.CASE SUMMARY An 82-year-old man presented with an unruptured abdominal aortic aneurysm measuring 83 mm×75 mm.The patient had a medical history of atrial fibrillation and was receiving rivaroxaban(15 mg/d).Routine pEVAR was performed using the preclose technique with ProGlide(Abbott,Santa Clara,CA,United States).Significant amount of bleeding was observed at the end of the procedure after the deployment of the closure device at the access site.A sheet of Surgicel was applied to the suture thread using a surgical needle.Surgicel was applied to the surface of the artery along the access tract using a pusher,and hemostasis was immediately attained.CONCLUSION This simple technique is an excellent adjunct to control residual bleeding from the access site following VCD use.

三维CTA和DSA图像融合技术对腹主动脉瘤腔内修复治疗术的效果评价

目的探讨三维CT血管造影(3D-CTA)和数字减影血管造影(DSA)图像融合技术在腹主动脉瘤腔内修复治疗术(EVAR)中的应用效果。方法选取102例行EVAR手术的患者,均行3D-CTA及DSA检查,并将3D-CTA检查图像与DSA数据进行图像融合,比较不同检查方法对各个征象以及术后并发症的检出率。结果3D-CTA与DSA图像融合技术对FL直径缩小、TL直径占比增加、支架近端FL血栓化、支架远端FL血栓化的检出率均高于3D-CTA及DSA检查(P<0.05)。三种检查方法对夹层破裂、内漏、支架近端逆行撕裂、新发夹层的检出率比较,差异无统计学意义(P>0.05)。结论3D-CTA和DSA图像融合技术在EVAR术后效果评估中具有重要意义,能够及时发现并发症,为临床干预提供可靠依据。

主动脉弓部病变不同弓上分支重建技术的疗效分析:单中心13年经验

目的比较主动脉弓部病变不同弓上分支重建技术的临床疗效。方法回顾性分析2010~2022年在中山大学附属第一医院接受弓上分支动脉重建的160例患者资料。根据主动脉弓上分支重建方法,将患者分为烟囱组(74例)、开窗组(19例)和分支组(67例),评估不同重建方式的短期及长期疗效。结果三组技术成功率均为100%。分支组围术期并发症发生率及二次干预率明显少于其他两组(并发症发生率:烟囱组23.0%,开窗组21.1%,分支组7.5%,P=0.037;二次干预率:烟囱组6.8%,开窗组15.8%,分支组1.5%,P=0.049)。总体随访率为89.2%,烟囱组、开窗组和分支组的中位随访时间分别为48、40.5和15个月。三组在全因死亡和并发症发生率的差异有统计学意义(全因死亡:烟囱组33.9%,开窗组11.1%,分支组3.3%,P<0.001;并发症发生率:烟囱组29.0%,开窗组11.1%,分支组11.7%,P=0.015)。Kaplan-Meier生存分析结果显示,50个月内除免于并发症发生率(P=0.049)外,烟囱、开窗和分支组累积生存率(P=0.249)、免于主动脉疾病相关死亡率(P=0.664)和免于二次干预率(P=0.753)差异有统计学意义。结论三种主动脉弓部病变弓上分支重建技术均安全有效,但烟囱技术远期内漏发生率较高,分支技术短期及远期效果较好。

3D打印辅助体外预开窗技术在复杂主动脉疾病腔内治疗的应用

目的探讨3D打印辅助体外预开窗技术在复杂主动脉疾病腔内治疗中的临床应用价值。方法回顾性分析2020年9月至2021年11月江阴市人民医院收治的10例复杂主动脉疾病患者临床资料。患者术前根据CTA影像制作3D打印模型,辅助体外定位预开窗位置,并结合支架束径技术完成腔内修复手术。结果患者均定位精准并顺利完成手术,无中转开胸和死亡病例。自制支架时间(56.00±12.20)min,手术时长(246.80±47.43)min,血管腔内操作时间(84.80±9.62)min,植入支架(3.80±1.03)个。患者术后无感染、出血、肝肾功能异常等并发症。术后随访8个月,1例患者失访,其余9例患者支架位置良好,分支通畅,病变重塑良好,无内漏。结论应用3D打印辅助体外预开窗支架可以精准定位,对复杂主动脉疾病患者的手术安全有效,术后恢复快、并发症低,患者临床获益更佳。

Endovascular treatment of wide-necked intracranial aneurysms using of ＂remodeling technique＂ with the HyperForm balloon

Background Aneurysms with wide-necked or a large neck/fundus ratio, especially located on an arterial bifurcation or a small artery, are challenges for interventional neuroradiologist because of the risk of coil migration or coil protrusion into the parent vessels. Our study was designed to improve the efficacy and safety of the ＂remodeling technique＂ with the HyperForm balloon for these difficult aneurysms and was confirmed by a follow-up result. Methods From June 2004 to September 2006, forty-two patients （20 men, 22 women） with wide-necked or large neck/fundus ratio aneurysms were treated by using the ＂remodeling technique＂ with the HyperForm balloon. Results Forty wide-necked aneurysms were successfully treated with the HyperForm balloon remodeling technique with only two failed cases. Final results consisted of total occlusion in 34 cases （80.9%）, subtotal in 4 （9.5%） and incomplete in 2 （4.8%）. One aneurysmal rupture occurred, but no clinical consequence was shown. No thromboembolic events were observed during treatment. Final angiographic follow-up time ranged from 3 to 18 months. Conclusions The ＂remodeling technique＂ with the HyperForm balloon is a very useful tool in the treatment of wide-necked or unfavorable neck/fundus ratio intracranial aneurysms - located on an arterial bifurcation or a small artery and, especially, located on the bifurcation of a large artery and a small one. In our experience, this technique provided a safe and efficient treatment for difficult aneurvsms when the standard remodelina techniaue miaht have failed.

Totally percutaneous thoracic endovascular aortic repair with the preclosing technique： a case-control study

Background The conventional thoracic endovascular aortic repair （TEVAR） involves groin incisions under general or epidural anesthesia. As technology moves towards less invasive procedures, a total percutaneous approach is desirable.In this study, we describe a Preclosing technique and investigate its safety and efficacy for femoral access sites management, and evaluate its advantages as compared to those of traditional surgical cutdown approaches.Methods The Preclosing technique involves two or multiple 6 F Perclose Proglide devices deployed in the femoral artery before upsizing to a 20-25 F sheath. The sutures were secured to close the arteriotomy at the end of the procedure. The medical records of patients who underwent thoracic endovascular aortic repairs using the Preclosing technique between December 2009 and November 2010 （group A） were compared with those using surgical femoral cutdown from January 2008 to November 2009 （group B）. Outcome measures included rates of technical success, early complications, anesthesia method, procedure time, cardiac care unit （CCU） stay, time from procedure to discharge,hospital stay, procedure expense, hospital cost.Results Between the two groups, there were no significant differences in baseline characteristics, in the endograft models or profiles. The technical success rate was 100.0% （85/85） in group A vs. 97.4% （147/151） in group B （P 〈0.05）.There was no access-related mortality in both groups. Compared with group B, the incidence of early complications were fewer in group A, 9.4% （8/85） vs. 22.5% （34/151） （P 〈0.01）. Local anesthesia with conscious sedation was used more often in group A, 68.2% （58/85） vs. 51.7% （78/151） in group B （P〈0.01）. The procedure duration was shorter, （96±33）minutes in group Avs. （127±41） minutes in group B （P〈0.01）. The length of the CCU stay, the duration from procedure to discharge, and the hospital stay were both reduced in group A, （117.3±88.3） hours, （7.5±5.3） days and （15.3±6.8） days vs. （132.7±115.5） hours, （10.5±5.0） days and （19.5±7.8） days in group B （P〈0.01）. The procedure cost was RMB （109 000±30 000） Yuan in group A vs. RMB （108 000±25 000） Yuan in group B （P=NS）. The hospital cost was RMB （130 000±35 000） Yuan in group A vs. RMB （128 000±33 000） Yuan in group B （P=NS）.Conclusions Total percutaneous TEAVR with the Preclosing technique is safe and effective with meticulous technique and appropriate patient selection. The Preclosing technique decreases access-related complications, depends less on general anesthesia and the surgeon＇s cooperation, saves procedure time and shortens the CCU/hospital stay. With these advantages, the use of two percutaneous closure devices increases the hospital cost only slightly.

Outcomes of Chimney and/or Periscope Techniques in the Endovascular Management of Complex Aortic Pathologies

Background：The chimney/periscope technique has been used to address complex aortic pathologies.This study aimed to report the outcomes and experiences of chimney and/or periscope grafts （CPGs） used in the endovascular management of complex aortic pathologies.Methods：Twenty-two patients with complex aortic pathologies were retrospectively studied from January 2013 to August 2016 in two vascular centers of teaching hospitals.All patients were diagnosed using computed tomography angiography （CTA）.The patients were followed up at postoperative 1,3,6,and 12 months and yearly thereafter with X-ray,ultrasound,and/or CTA.Results：Twenty-two cases （17 males;mean age 60.7 ＆#177; 16.3 years） with complex aortic pathologies were analyzed.Nineteen patients underwent CPGs only,and the other three cases underwent the simultaneous implantation of chimney/periscope and fenestrated/scallop grafts.Twenty-six arteries were managed with forty CPGs during the procedures.Complete angiographies revealed two Type Ⅰ endoleaks,one Type Ⅲ endoleak,and one Type Ⅳ endoleak.Other intraoperative complications included brachial thrombosis,external iliac artery rupture,and left renal stenosis.The 30-day mortality was 0.The mean follow-up was 26.1 ＆#177; 10.1 months with a range of 2-39 months.During the follow-up,two Type Ⅰ endoleaks and one Type Ⅳ endoleak were observed.One right renal stent occlusion occurred in the 5th month and turned patent after reintervention.Three patients died during the follow-up,one due to an aneurysm rupture as a Type Ⅰ endoleak,and two due to myocardial infarction.The instant technical success was 96%.The primary and secondary patencies were 92%and 96%,respectively.The overall survival rates were 95%,84%,and 84% at 12,24,and 36 months,respectively.Stent migration was not observed in any patient.Conclusions：Chimney/periscope techniques could be used to tackle complex aortic pathologies,but the indications must be strictly controlled,and additional experiences are required.

Endovascular Treatment of the Huge Dissecting Aneurysms Involving the Basilar Artery by the Internal Trapping Technique： Technical Note

Background： The endovascular strategy of the huge dissecting aneurysms involving the basilar artery （BA） is controversial and challenging. This study was to investigate the clinical and angiographic outcomes of the treatment of the huge dissecting aneurysms involving the BA by the internal trapping （IT） technique. Methods： We retrospectively studied 15 patients with the huge dissecting aneurysms involving the BA treated by the IT technique between September 2005 and September 2014 in Department of Interventional Neuroradiology of Beijing Tiantan Hospital. Clinical and angiographic data were reviewed and evaluated. Results： All patients were treated by the IT technique. That meant the dissecting artery and aneurysm segments were completed occlusion. After the procedure, the angiography demonstrated that all the dissecting artery and aneurysm segments were completed occlusion. Follow-up angiography was performed at 3-6 months or 12-18 months alter the endovascular treatment （median 8 months）, 14 patients had a good recovery. Re-canalization occurred in one patient whose aneurysm involved in bilateral vertebral arteries and the two third of the middle-lower BA. After the second treatment, the patient died by the ventricular tachycardia. Conclusions： The IT technique is a technically feasible and safe alternative for the treatment of BA dissecting aneurysms, but it is not necessarily the safest or most definitive treatment modality. The ideal treatment of the huge dissecting aneurysms involving the BA remains debatable and must be investigated on a case-by-case basis.

腔内导管搅拌溶栓在布-加综合征合并下腔静脉及肝静脉血栓中的应用

目的 分析腔内导管搅拌溶栓治疗伴下腔静脉及肝静脉新鲜血栓的布-加综合征(BCS)的安全性和有效性。方法 回顾分析我院22例BCS伴下腔静脉及肝静脉新鲜血栓患者的临床资料,患者均接受经导管搅栓溶栓、血栓抽吸及经皮血管成形术等腔内介入治疗。统计患者治疗后血栓清除及并发症发生情况。结果 21例患者下腔静脉及肝静脉新鲜血栓完全清除,1例患者溶栓后消化道出血,终止治疗,且随访期间失访。22例患者围术期均未出现肺栓塞症状。随访期间,21例患者下腔静脉及肝静脉血流通畅,无血栓形成、明显狭窄及肺动脉栓塞发生,患者临床症状及体征完全消失,11例植入支架的患者支架无明显移位或断裂。结论 腔内导管搅拌溶栓治疗BCS合并下腔静脉及肝静脉新鲜血栓安全有效,可有效清除下腔静脉及肝静脉新鲜血栓,避免肺动脉栓塞的发生。

介入法建立长期可随访冠状动脉微栓塞动物模型

目的应用微导管介入技术建立可随访的冠状动脉微栓塞动物模型。方法10只巴马系小型猪经导管选择性的于前降支(LAD)内注入15×104个微栓塞球(直径45μm),致使冠状动脉微血管栓塞。分别测量冠脉血流储备分数(CFR)和左室射血分数(LVEF);心肌组织切片染色和超微结构变化观察;及术后1个月再行血管造影及CFR测量等检验。结果冠脉内注射微栓塞球可导致微血管完整性的破坏(CFR<2.0)及左室功能障碍(LVEF<50%)。组织切片NBT和HE染色均证实存在微血管栓塞;透射电镜微梗塞区心肌细胞水肿、纤维化明显;术后动物存活率高(n=10),且可再行经皮血管造影及CFR的测量。结论应用微导管介入技术可建立创伤小、死亡率低并可长期随访观察的小型猪冠状动脉微栓塞模型。是临床研究冠脉微血管栓塞发病机制的理想动物模型。

猪急性冠状动脉微栓塞模型的建立

目的应用微导管介入技术建立小型猪急性冠状动脉微栓塞(CME)模型。方法巴马系小型猪随机分为假手术组和微栓塞组(CME组);CME组再按微球数目不同分为5万、10万、15万、25万微球亚组(各组存活小型猪均为5头)。CME组通过经皮冠状动脉介入法,于前降支中远端,经微导管注入微栓塞球,假手术组注射生理盐水,各组术后9 h分别应用心脏超声检测心功能,HE染色和苏木素碱性复红苦味酸(HBFP)染色检测心肌微梗死面积。结果①超声心动图参数显示,与假手术组比较,5万微球组心功能无明显改变(P>0.05);与假手术组比较,10万微球组、15万微球组、25万微球组左心室射血分数(LVEF)均显著下降(P<0.05),心脏超声表现为左心室短轴缩短率(FS)和心排血量(CO)下降及左心室舒张期末内径(LVEDd)增加。②CME各组均出现心肌微梗死灶,与5万微球组(4.62%±2.17%)比较,10万微球组(9.23%±3.97%)、15万微球组(12.24%±4.73%)、25万微球组(21.52%±6.19%)微梗死面积均明显增加(P<0.05);③不同CME组之间比较,LVEF与微栓塞球数目成负相关(r=-0.74,P<0.05)、心肌微梗死面积与微栓塞球数目成正相关(r=0.87,P<0.05)。④心肌HE、HBFP染色示:10万微球组基本在每张切片均可发现微梗死灶,并且不引起大面积的心肌梗死。结论经微导管于左前降支中段注射10万计数微球可以成功制作小型猪急性CME模型。

介入法犬股骨头坏死模型制作

目的应用介入方法建立犬股骨头坏死模型。方法9只成年杂种犬全麻后,分别通过股动脉Seldinger法穿刺插管,超选一侧股骨头供血动脉行平阳霉素灌注及明胶海绵栓塞处理,建立股骨头缺血坏死模型,对侧股骨头作对照。模型犬随机分为3组,每组3只,分别于栓塞术后2、4、6周处死。所有犬均于栓塞术前及术后每周行双侧髋关节MRI扫描,栓塞术前、术后即刻、处死前行双侧股骨头供血动脉DSA造影检查,最后一次造影结束处死动物,取双侧股骨头标本送病理学观察。结果9只犬均造模成功,术后所有栓塞动脉造影复查均未见再通。造模侧股骨头在术后2周出现早期病理学改变,术后4周MRI显示股骨头坏死异常信号,病理切片出现不同程度骨细胞及骨小梁坏死,术后6周病理切片可见坏死后增生及修复反应。结论本法能成功制作出犬股骨头坏死模型,具有创伤小、造模方法简单、成模时间短、动物死亡率低等优点,是一种比较理想的造模方式。

血管缝合器预缝合技术完全经皮穿刺途径完成主动脉腔内修复术后的股动脉中长期随访结果

目的：探讨采用血管缝合器（vascular closure device, VCD）预缝合技术完全经皮穿刺途径完成主动脉腔内修复术（endovascular aortic repair, EVAR）的股动脉中长期随访结果。方法自2009年7月~2012年7月，113例主动脉瘤或夹层患者行EVAR，其中男性106例，女性7例，年龄29~85（59.4＆#177;13.5）岁。Stanford B型主动脉夹层60例，胸主动脉瘤3例，肾下型腹主动脉瘤48例，另有2例同时发现胸及腹主动脉瘤。65例胸主动脉的EVAR术分别缝合1条股动脉，50例腹主动脉的EVAR术分别缝合2条股动脉，共缝合165条股动脉。均采用VCD（Perclose ProGlide,美国Abbott）预缝合技术经皮穿刺途径完成EVAR术。术后采用CT或彩超随访股动脉，评价双侧股动脉缺血情况。结果113名患者成功完成115例次EVAR术（其中2名合并胸腹主动脉瘤患者分期共行4次EVAR术），共采用347枚VCD修复165条股动脉。使用支架输送器外径包括14 Fr 38例，16 Fr 12例，18 Fr 25例，20 Fr 24例，22 Fr 29例，24 Fr 37例。其中1条股动脉缝合失败，2条缝合后出现即时急性闭塞，1例术后1月出现右股动静脉瘘，均行外科处理痊愈，缝合成功率为97.6%（161/165）。分组统计2枚VCD缝合成功率，结果显示≤18Fr组缝合成功率明显优于≥20Fr组（分别为98.7%和81.1%，P=0.0003）。分组统计前后50%病例的2枚VCD缝合成功率，结果分别为82.9%和95.2%（P=0.013）。术后随访12~50（26＆#177;9）月未发现下肢动脉缺血症状发生，CT或彩超提示未见有明显股动脉狭窄。结论采用VCD预缝合技术完全经皮穿刺途径完成EVAR术安全可行，对于合适的病例，在度过学习曲线后可作为传统股动脉切开的备选方法。输送器外鞘外径大于或等于20Fr可能是缝合失败需转外科处理和需2枚以上VCD缝合的影响因素。