分叉型一体式覆膜支架腔内治疗肾下型腹主动脉瘤的疗效

目的:探讨应用分叉型一体式覆膜支架腔内治疗腹主动脉瘤和髂动脉瘤的疗效。方法:回顾分析采用分叉型一体式覆膜支架治疗的20例肾下型腹主动脉瘤和髂动脉瘤患者的临床资料。结果:20例患者植入分叉型一体式覆膜支架的手术成功率达100%,无围手术期死亡患者,且所有患者均未出现各类缺血性并发症。8例患者术后存在少量内漏(6例Ⅰ型内漏,2例Ⅲ型内漏),1周后内漏消失;1例患者术后发生急性肝肾功能不全,经内科治疗1周后恢复;2例患者术后出现腹股沟切口淋巴瘘,经换药愈合。平均随访15个月,所有患者未出现新的内漏和支架移位。1例患者术后1年在左侧分支支架内形成血栓,左侧髂动脉局部无血流,经导管接触溶栓治疗1 d后实现血管再通。结论:应用分叉型一体式覆膜支架腔内治疗腹主动脉瘤安全有效。     

腹主动脉瘤行腔内隔绝术的手术配合

[目的]总结腹主动脉瘤行腔内隔绝术的手术配合。[方法]对37例腹主动脉瘤病人行腔内隔绝术,同时给予密切护理配合。[结果]37例病人均成功行 EVG手术,其中分叉型覆膜支架33例和直筒型覆膜支架（4例）,手术均顺利,术毕造影均未见明显Ⅰ型内漏、血管出血或支架移位等并发症;术后病人均康复出院。[结论]加强腹主动脉瘤行腔内隔绝术的手术配合是手术成功的保证。     

三分叉覆膜支架血管治疗A型主动脉瘤夹层手术的护理配合

目的探讨三分叉覆膜支架血管治疗A型主动脉瘤夹层手术的护理配合。方法对19例行三分叉覆膜支架血管治疗A型主动脉瘤夹层患者进行术前护理包括做好访视、健康教育,备齐手术用物和术中配合包括麻醉、体位摆放、根据手术需要调节手术间温度、做好皮肤和管道等护理。结果 19例患者手术顺利。住院15~36 d,平均25.5 d。术后随访1~4个月,19例患者的主动脉弓部及头臂动脉内支架扩张贴壁满意,相应部位假腔消失或血栓填塞。无与支架覆膜血管相关的并发症。结论对三分叉覆膜支架血管治疗A型主动脉瘤夹层这类特大手术,充分的术前准备、熟练的术中配合及术后访视有利于手术的顺利实施,有利患者康复。     

彩色多普勒超声在腹主动脉瘤腔内修复术后内漏中的应用价值

目的探讨彩色多普勒超声在腹主动脉瘤腔内修复术后内漏并发症诊断中的应用价值。方法 30例肾下型腹主动脉瘤进行腔内带膜内支架置入术后1、3、6个月行彩色多普勒超声检查,明确其并发症有无内漏、内漏的位置及内漏分型;同期,所有检查者均行CTA检查,二者对照。结果 30例检查者术后1个月彩色多普勒超声检出内漏有7例,其中Ⅰ型4例(远端3例、近端1例);Ⅱ、Ⅲ、Ⅳ型各1例);CTA检查结果显示未见Ⅳ型内漏,其余各型均与彩色多普勒超声诊断结果一致;术后3个月复查,其中Ⅰ型1例死亡,其余3例及Ⅲ型1例经临床二次治疗后,彩色多普勒超声检查内漏消失;未经治疗的1例Ⅱ型内漏仍然存在,上述结果与CTA均符合;彩色多普勒超声与CTA均未显示Ⅳ型内漏;术后6个月复查,彩色多普勒结果与CTA结果相符,均与术后3个月复查结果相同。彩色多普勒超声对腹主动脉瘤腔内修复术后内漏并发症诊断的灵敏度100%、特异度95.8%、准确度86.7%、阳性似然比23.0。结论彩色多普勒超声诊断腹主动脉瘤腔内修复术后内漏并发症特异度、灵敏度、准确度较CTA高,且无创、无辐射、可以重复操作等优势,能够为临床治疗提供可靠的依据。     

下行双导丝技术在复杂腹主动脉瘤腔内治疗中的应用

目的 探讨下行双导丝技术在复杂腹主动脉瘤腔内隔绝术（EVAR）中操作要点和应用价值.方法 回顾2007年7月至2011年10月14例复杂腹主动脉患者采用下行双导丝技术经双侧股动脉植入覆膜支架,对腹主动脉瘤进行腔内支架治疗.结果 14例手术获成功,手术时间为2～3 h,其中1例术后出现单侧下肢缺血：随访3～24月,14例均生存良好,未发生支架移位、严重内漏及肾功能衰竭等严重并发症.结论 下行双导丝技术在腔内支架治疗复杂解剖形态腹主动脉瘤中,具有操作时问短、操作容易、安全性高等优点,值得推广.     

覆膜支架腔内隔绝术治疗Stanford B型主动脉夹层10例的护理

目的探讨10例覆膜支架腔内隔绝术治疗StanfordB型主动脉夹层的护理经验。方法回顾性分析10例经股动脉置管覆膜支架腔内隔绝术治疗StanfordB型主动脉夹层的临床资料,探讨覆膜支架腔内隔绝术治疗StanfordB型主动脉夹层的护理。结果所有患者术后2周复查CTA,显示支架位置良好,无移位、扭曲;术后3个月复查,1例出现轻度内漏,无胸背部疼痛等症状,术后6个月再次复查内漏自行闭合。结论覆膜支架腔内隔绝术是治疗StanfordB型主动脉夹层安全、有效的治疗手段,术前全面准备和术后精心护理对于保证手术成功,降低病死率十分重要。     

覆膜支架封闭左锁骨下动脉治疗胸主动脉瘤的临床疗效

目的探讨覆膜支架修复术治疗胸主动脉瘤时封闭左锁骨下动脉的临床疗效。方法2011年3月至2012年3月,23例患者行覆膜支架腔内修复术治疗胸主动脉瘤时封闭左锁骨下动脉。StanfordB型主动脉夹层13例,假性动脉瘤7例,主动脉穿透性溃疡3例。所有患者于术前经过螺旋CT血管造影（CTA）检查,显示主动脉夹层或假性动脉瘤破口与左锁骨下动脉的距离均小于1．5cm,并经过血管超声及CTA检查了解颈动脉、椎动脉及大脑Willis动脉环情况。随访6～12个月,分析临床效果。结果23例患者支架全部成功置入。术后左上肢平均动脉压均有不同程度的降低（30-45mmHg）。18例患者左上肢桡动脉搏动减弱或消失,但运动感觉无受限。随访6～12个月,无神经系统症状发生,3例有左上肢轻度缺血和肌肉轻度萎缩。15例患者于出院后6个月接受CTA复查,发现破口完全封闭,假腔内血栓形成,均未发现支架移位和内漏。结论覆膜支架治疗胸主动脉瘤时封闭左锁骨下动脉是可行的,但需要充分的术前准备。远期疗效还有待进一步观察。     

6例胸腹主动脉夹层的腔内隔绝术治疗

目的探讨腔内隔绝术治疗胸腹主动脉夹层的经验和效果。方法 4例胸主动脉夹层和2例腹主动脉夹层病人接受腔内隔绝术治疗,术前均行彩超、三维重建螺旋CT、MRI等检查确诊。结果术后DSA造影显示：6例动脉夹层消失,覆膜支架近远端与主动脉结合处无内漏,支架无移位。术后3～6个月彩超及CT随访显示腔内覆膜支架无移位及内漏。结论腔内隔绝术是一种创伤小、并发症少的治疗胸腹主动脉夹层的安全、有效的方法。     

彩色双功超声扫描在腹主动脉瘤血管内修复术后随访的价值

目的评价彩色双功超声扫描(CDUS)在腹主动脉瘤(AAA)血管内修复术(EVR)后随访的价值.方法用CDUS对28例腹主动脉瘤血管内修复术后患者进行随访,将有内漏者与计算机断层扫描血管造影(CTA)进行比较.结果检出内漏4例5人次占14.29%,其中Ⅰ型内漏2例占7.14%,Ⅱ型内漏2例占7.14%,Ⅲ型内漏1例占3.57%;血管内支架分支阻塞2例占7.14%;腹股沟血肿2例占7.14%.结论 CDUS对于AAA血管内修复术后的随访检查能确定内漏的类型及病因血管;有无支架狭窄或血栓形成等并发症.     

血管腔内覆膜支架植入术治疗腹主动脉瘤的护理

目的 总结血管腔内覆膜支架植入术治疗腹主动脉瘤患者围手术期并发症的预防、观察和临床护理要点.方法 对2008年1-8月行血管腔内覆膜支架植入术治疗的27例腹主动脉瘤患者的临床资料进行回顾性分析.结果 27例手术均获成功,术后未发生严重并发症,治疗及护理效果良好.结论 有效的护理措施是保证治疗成功的重要因素.     

Endovascular Leaks: Perioperative Nursing Implications

Endovascular repair is becoming the gold standard treatment for aortic aneurysm disease. With the development of new treatment modalities, however, new and unique complications arise. Endovascular stent graft leaks (ie, endoleaks) are one such complication.Endoleaks occur when blood leaks into the aneurysm sac after an endovascular stent repair. Endoleaks are divided into four categories (ie, I through IV) depending on the site of origin; perioperative nurses must become familiar with treatment options for each type of endoleak. AORN J 89 (May 2009) 839-846. © AORN, Inc, 2009.     

Diagnosis and Management of Endoleaks After Abdominal Aortic Aneurysm Repair

A ruptured abdominal aortic aneurysm (AAA) can be a life-threatening condition. When AAAs are discovered, they are repaired via endovascular techniques. Endovascular repair of AAAs offers a decrease in operative mortality when compared with open repair of AAAs. However, this technique has given birth to postoperative endoleaks. An endoleak allows for continued pressurization of the AAA and therefore leads to continued growth and rupture risk. Radiology plays an integral part in the diagnosis and management of postoperative endoleaks after endovascular repair of AAA.     

二维彩色多普勒超声在腹主动脉瘤腔内隔绝术的应用价值

目的⑶探讨二维彩色多普勒超声在腹主动脉瘤腔内隔断术的应用价值⒚方法⑶应用二维彩色多普勒超声⒉２ Ｄ Ｃ Ｄ Ｕ Ｓ⒕对 １４ 例 Ａ Ａ Ａ 腔内隔绝术前后进行检测⒙术前重点观察瘤颈的长度、瘤体的大小、瘤体出口距髂动脉分叉的距离等⒛术后重点检测瘤体与血流隔绝情况⒙有无内漏等并发症⒙将 ２ Ｄ Ｃ Ｄ Ｕ Ｓ 检测结果与螺旋 Ｃ Ｔ、数字减影血管造影相对照⒚结果⑶超声在术前诊断 Ａ Ａ Ａ 的敏感性为 １０ ０％ ⒚术后成功地观察到了所有 Ａ Ａ Ａ 腔内移植物⒙其中 ４ 例患者发现内漏⒙经螺旋 Ｃ Ｔ 检查证实⒚结论⑶２ Ｄ Ｃ Ｄ Ｕ Ｓ 在 Ａ Ａ Ａ 腔内隔绝术术前可进行准确诊断⒙术后可对疗效评价⒚     

DeBakeym型主动脉夹层腔内修复治疗并发症的处理与分析

目的总结近年来我科DeBakey III型主动脉夹层腔内修复治疗的经验,重点探讨围术期发生的并发症及其预防与处理。方法回顾性分析自2009年1月至2011年1月的2年间我科完成49例DeBakey III型主动脉夹层腔内修复治疗患者的临床资料。结果无术后近期死亡、无截瘫。严重的并发症有昏迷2例（4．1％）、内漏2例（4．1％）、上肢缺血2例（4．1％）。新发近端夹层1例。术后多数患者存在不同程度发热。结论腔内修复治疗能够降低夹层治疗的病死率,但严重并发症不容忽视。降低逆行性夹层、急性脑供血不足、内漏等并发症可以进一步改善患者的预后,提高生存质量。     

Endoluminal repair of infrarenal abdominal aortic aneurysms

Endoluminal repair of abdominal aortic aneurysms (AAA) offers an attractive alternative to open surgical repair. Early experience has shown that endoluminal repair can be performed safely, with low morbidity and mortality rates. Data from non-randomised studies have demonstrated that the endoluminal technique has certain advantages when compared with open repair in carefully selected patients. These include shorter hospital stay, decreased use of intensive-care beds and lower blood loss. The major drawback to endoluminal repair is the durability of the stent grafts. Registers of endoluminal devices have shown that, even after successful repair, new endoleaks may occur after apparently successful deployment and the transverse diameter of the aneurysm may continue to expand, even in the absence of an endoleak. Some of the devices have developed problems with the integrity of either the stent or its graft covering, which could result in aneurysm rupture. Manufacturers have recently been criticised for not releasing data on adverse events. No randomised trials comparing endoluminal with open repair of infrarenal AAA have yet been performed, however, financial support has recently been granted for a multicentre UK study (endovascular aneurysm repair — EVAR). This trial will randomise patients who are deemed fit for operation to either open repair or endovascular repair (EVAR 1) and patients regarded as unfit to best medical treatment, or best medical treatment with endovascular repair (EVAR 2).     

DeBakeyⅢ型主动脉夹层腔内修复治疗并发症的处理与分析

目的 总结近年来我科DeBakeyⅢ型主动脉夹层腔内修复治疗的经验,重点探讨围术期发生的并发症及其预防与处理.方法 回顾性分析自2009年1月至2011年1月的2年间我科完成49例DeBakeyⅢ型主动脉夹层腔内修复治疗患者的临床资料.结果 无术后近期死亡、无截瘫.严重的并发症有昏迷2例(4.1％)、内漏2例(4.1％)、上肢缺血2例(4.1％).新发近端夹层1例.术后多数患者存在不同程度发热.结论 腔内修复治疗能够降低夹层治疗的病死率,但严重并发症不容忽视.降低逆行性夹层、急性脑供血不足、内漏等并发症可以进一步改善患者的预后,提高生存质量.     

Treatment of Abdominal Aortic Aneurysms: The Role of Endovascular Repair

Rupture of an abdominal aortic aneurysm (AAA) is a significant cause of mortality in the United States. Often asymptomatic, AAA is considered a silent killer because it frequently remains undiagnosed until the time of rupture or the patient’s death. Major risk factors, such as smoking, age, sex, race, and family history of aortic aneurysm, affect the formation of AAAs. National screening recommendations and advancements in treatment modalities during the past 20 years have improved morbidity and mortality, especially with the introduction of stent grafts for endovascular repair of the aorta. Endovascular aneurysm repair is less invasive than open surgical repair. This article describes the major risk factors, pathophysiology, and diagnosis of AAA; patient selection for endovascular repair; common adverse events and complications; and perioperative implications for the patient undergoing endovascular repair of an AAA. Knowing the treatment options for patients with AAA who are at high risk for rupture should allow clinicians to determine the best course of immediate and long-term care. Patients who undergo endovascular repair of an AAA should receive lifelong monitoring for complications, especially endoleaks.     

Endovascular abdominal aortic aneurysm repair.

Endovascular abdominal aortic aneurysm (AAA) repair is a new, less-invasive approach to traditional AAA repair. This innovative technique may provide the patient with significant benefits, including a less-invasive procedure, fewer postoperative complications, and early discharge home. In many cases, the patient will be transferred after the procedure to the PACU and then discharged to the general floor or telemetry unit, eliminating the need for an ICU stay.