腹主动脉瘤的治疗

目的 探讨腹主动脉瘤(AAA)的治疗方法。方法 回顾性分析26例AAA的临床资料。结果 26例中夹层动脉瘤3例，真性动脉瘤21例，动脉瘤破裂后再形成的假性动脉瘤1例，动脉瘤穿破十二指肠空肠曲形成腹主动脉肠瘘1例。病变累及肾动脉平面以上者3例，肾动脉平面以下者23例：病变仅累及腹主动脉者4例，病变除累及腹主动脉外，尚合并有单侧或双侧髂总动脉瘤者／2例，合并双侧髂总动脉瘤及一例或双侧髂内动脉瘤者5例，合并一侧髂总、髂内、髂外动脉瘤1例，合并有双侧髂总、髂内、髂外动脉瘤1例。施行紧急手术治疗3例，择期手术治疗14例，施行支架型人工血管腔内微创治疗7例，未手术2例。术后发生并发症3例，无瘫痪、下肢动脉栓塞等发生。术中及术后30d死亡率为3．8％(1例)。支架型人工血管治疗的7例无漏血、移位等并发症发生，均痊愈出院。22例随访3个月至4年，均存活良好。结论 AAA的腔内血管外科治疗具有创伤小，术石恢复快，并发症少等优点，有条件行支架型人工血管作腔内治疗的应优先考虑腔内治疗，传统手术方法在技巧等方面的改进有利于提高手术的成功率，并能为不具备腔内治疗条件的患者解除疾患。     

主动脉病变的手术治疗与腔内血管外科治疗

目的 探讨主动脉病变的手术治疗和腔内血管外科治疗方法。方法 回顾性分析45例胸腹主动脉病变外科治疗的临床资料。结果 男37例，女8例。年龄2l～85(平均年龄64、7)岁。其中胸主动脉夹层ll例；降主动脉夹层破裂并假性动脉瘤形成伴椎骨破损2例；肾上，下型腹主动脉瘤各为3，23例；腹主动脉瘤破裂2例；腹主动脉瘤空肠瘘l例；腹主动脉外伤性破裂3例。45例患者中腔内治疗者l8例，25例行人工血管置换治疗，3例行腹主动脉修补。围手术期死亡率为6．7％(3／45)。随访36例，随访时间2个月～4年，均生存良好。结论 腔内血管外科治疗有着创伤小，术后恢复快，并发症少等优点，有条件行支架型人工血管腔内治疗的可优先考虑腔内治疗。传统手术方法在技巧等方面的改进有利于提高手术的成功率，并能为不具备腔内治疗条件的患者解除疾苦。     

支架型人工血管临床应用的初步经验

目的探讨支架型人工血管治疗各类动脉瘤的临床效果。方法本组包括夹层动脉瘤 4 8例 ;腹主动脉瘤 13例 ;降主动脉、左锁骨下动脉、肾下和肾上腹主动脉假性动脉瘤分别为 4例、1例、2例和 1例 ;左、右髂动脉瘤各 1例。对夹层动脉瘤和假性动脉瘤均行破口封堵术 ,真性腹主动脉瘤行隔绝术。结果本组均获技术成功。围手术期死亡 2例。 5例夹层动脉瘤术后近侧有少量残余漏 ,但 4例半年后近侧渗漏消失 ,9例残存远侧破口少量返流。腹主动脉瘤 6例术后即时有轻度内漏 ,3个月后 5例内漏消失。结论支架型人工血管治疗夹层动脉瘤、假性动脉瘤和真性动脉瘤手术微创、安全 ,但其远期疗效需进一步观察。     

少见的主动脉病变的腔内隔绝术：附8例报告

总结腔内隔绝术治疗少见大动脉疾病的疗效。8例少见大动脉疾病，均采用腔内隔绝术进行治疗，报告其术前，手术及术后的情况。8例大动脉疾病患者（Stanford A型主动脉夹层3例，Stanford B型主动脉夹层1（转流后）, 主动脉弓部真性动脉瘤3例，肾水平腹主动脉瘤1例）。Stanford A型主动脉夹层2例术后因并发症死亡，余患者全部存活，随访生活质量良好。腔内隔绝术治疗大动脉疾病具有创伤小，疗效可靠的优点，其远期效果尚有待近一步观察。     

血管腔内支架植入术的临床应用

目的 评价应用血管内支架治疗血管性疾病的临床价值。方法 对36例患有血管性疾病的患者施行了血管内支架植入术，包括胸主动脉夹层动脉瘤24例，腹主动脉真性动脉瘤3例，腹主动脉夹层动脉瘤1例，颈动脉动静脉瘘1例，左锁骨下动脉狭窄1例，左锁骨下动静脉瘘1例，髂动脉假性动脉瘤4例及股动脉狭窄1例。除1例左锁骨下动脉狭窄患者、1例股动脉狭窄患者使用了裸支架外，其余34例患者均采用带膜支架进行血管内治疗。结果 术中所有患者均未出现特殊不适，术后随访期间未见明显合并症发生。所有患者均完全消除了临床症状。结论 应用血管内支架治疗血管性疾病是一种实用且效果较好的治疗方法。     

复杂主动脉病变的腔内血管外科治疗

目的 探讨复杂主动脉病变的腔内血管外科治疗方法。方法 对21例合并有内脏动脉缺血等复杂的主动脉病变,双球管定位下经锁骨上动脉到股动脉交换导丝以确保真腔内植入带膜支架,对真腔完全被假腔压闭的患者采取真腔内加压推进以通过导丝,用超长带膜支架来封堵大破口治疗夹层合并巨大假性动脉瘤形成,对夹层合并腹主动脉瘤患者采取血管腔内技术联合开腹手术等方法。结果 术后内漏3例,其中2例7 d后停止,1例漏血持续存在。3例主动脉创伤术后完全康复,余18例复杂主动脉夹层术后即时造影示瘘口已被完整覆盖,假腔无血漏入,内脏动脉等恢复真腔供血。18例中6例合并肠管缺血,3例合并肾动脉缺血,3例肠管缺血、肾动脉缺血,2例腹主动脉真腔完全被假腔压迫,以及2例合并下肢缺血术后均逐渐恢复,无脏器及肢体缺血坏死发生。2例合并腹主动脉瘤夹层行支架型人工血管封闭夹层破口后行开腹手术切除腹主动脉瘤、人工血管置换。16例随访5～36个月,平均22.3月,1例内漏持续存在,但假腔未继续加大,其余患者存活良好。结论 对复杂的主动脉病变的治疗,通过对腔内血管外科技术进行改进,并适当结合传统手术方法,使某些过去被认为不能够治疗的复杂主动脉病变可得以成功治疗。     

主动脉病变腔内修复术中导入动脉的外科处理

目的 探讨主动脉病变腔内修复术中对于导入动脉的外科处理方式。方法 回顾性分析南方医科大学南方医院血管外科2001年1月至2007年12月63例主动脉腔内修复术病人的临床资料,其中主动脉夹层33例,腹主动脉瘤25例,主动脉假性动脉瘤5例。结果 导入动脉分别选用股总动脉57例,髂外动脉6例。动脉切口单纯修补38例,动脉成形后修补16例,内膜剥除加单纯修补4例,动脉部分切除后行端端吻合4例,人工血管置换1例。62例病人获得成功,1例术中死亡。所有成功施行腔内隔绝术的病人中,1例术后出现导入动脉假性动脉瘤,通过再次手术治愈;2例术后出现患侧下肢轻微缺血症状,经造影证实为吻合口狭窄,予以保守治疗治愈,其他病人未出现并发症。 结论 术前详尽的评估,术中仔细的保护,术后根据情况及时进行相应处理,可有效防治导入动脉相关的并发症。     

腹主动脉瘤的诊断和治疗体会

作者报道自1996年11月以来,手术治疗4例腹主动脉瘤的体会。4例中,胸腹主动脉瘤、腹主动脉瘤破裂并十二指肠瘘、腹主动脉瘤+双髂总动脉瘤、腹主动脉瘤+双髂总动脉瘤+双髂内动脉瘤+双股动脉瘤各1例。作者总结了有关腹主动脉瘤的临床诊断,CT、DSA对腹主动脉瘤的诊断意义,以及手术方式选择的初步体会。     

大动脉外科疾病的腔内治疗

发生于大动脉的外科疾病主要是真性动脉瘤、夹层动脉瘤和假性动脉瘤等动脉扩张病。早在1684年,Moore将一段金属丝导入腹主动脉瘤腔内,希望促发瘤内血栓形成。这是人类的首次大动脉腔内治疗尝试,而其真正的发展仅仅是最近20年的事。上世纪80年代中后期开始了动脉瘤腔内隔绝系统的实验研究,到1990年,Parodi成功地施行了世界上第一例腹主动脉瘤腔内隔绝术,在国内,笔者于1997年率先开展了该手术[1],并在此后迅速推广应用于胸主动脉瘤、夹层动脉瘤、假性动脉瘤和动静脉瘘等疾病的治疗。1主动脉真性动脉瘤的腔内治疗发生在主动脉的真性动脉瘤可分…     

支架型人工血管腔内治疗复杂主动脉瘤

目的：总结15例应用支架治疗复杂动脉瘤的初步经验。方法：Ⅲ型夹层动脉瘤者主动脉极度扭曲1例；破口在弓部的Ⅲ型夹层动脉瘤1例，需先行左右颈-颈和左右腋．腋动脉人工血管搭桥后再封闭左侧颈总动脉和锁骨下动脉：Ⅲ型夹层动脉瘤近侧破口来自于变异发出的右锁骨下动脉1例；Ⅲ型夹层动脉瘤合并肠系膜上动脉几乎完全闭塞和肠缺血1例；Ⅲ型夹层动脉瘤真假腔难判断者4例；腹主动脉瘤瘤颈长度〈1cm需开窗型支架治疗1例；破裂腹主动脉瘤1例：5枚支架治疗胸腹主动脉瘤1例；腹主动脉瘤瘤颈夹角为90。2例；主动脉溃疡紧邻腹腔动脉，需开窗型支架开窗型人工血管治疗1；肝动脉瘤腹腔动脉瘤合并动静脉瘘1例。结果：15例病人经支架治疗均获得成功。结论：支架型人工血管治疗复杂动脉瘤为微创方法，但需严密设计。     

Type B aortic dissection with rupture of the left common iliac artery: a case report

Type B aortic dissection involves the appearance of a false lumen distal to the left subclavian artery and extending distally into the descending thoracic aorta and into the abdominal aorta. Complications of the dissection include rupture of the thoracic aorta, leg ischemia, visceral ischemia, and renal failure. A 37-year-old man presented with complaints of sudden onset of chest pain, left leg pain, and numbness. Examination revealed no femoral, popliteal, or distal pulses with decreased sensory and motor function on the left lower extremity. A CT scan revealed an aortic dissection at the proximal descending aorta extending into the iliac arteries with a left retroperitoneal hematoma at the iliac bifurcation. An MRI confirmed the dissection distal to the left subclavian artery into the iliac artery with a distal occlusion. Exploration revealed rupture of the left iliac artery dissection with arterial occlusion and a contained hematoma. The common iliac artery was ligated and an 8-mm Dacron bypass graft from the right common femoral artery to the left femoral artery was performed. Type B aortic dissection can present as rupture of the common iliac artery. Revascularization of the extremity with a femoral-femoral crossover graft is the recommended procedure in the absence of visceral ischemia. The surgeon should have a keen suspicion of this rare complication and its management.     

白塞病并发动脉瘤12例的外科治疗体会

目的总结白塞病并发动脉瘤的外科手术和腔内治疗经验。方法对1977年6月至2006年3月收治的12例白塞病患者并发21个动脉瘤进行回顾性分析。腹主动脉瘤3个,升主动脉瘤1个,髂动脉瘤4个,髂动脉吻合口假性动脉瘤1个,股总动脉瘤3个,股浅动脉瘤2个,腘动脉瘤2个,椎动脉瘤1个,锁骨下动脉瘤2个。颈动脉瘤1个和肠系膜上动脉瘤1个。21个动脉瘤中,行外科手术14个,包括动脉瘤切除、人工血管或自体大隐静脉移植术12个,动脉瘤切除、病变动脉结扎术2个;行支架型人工血管腔内修复术6个;1个升主动脉瘤因患者全身情况差,行保守治疗。结果围手术期死亡患者2例,其中1例行外科手术,1例行腔内修复术。术后吻合口假性动脉瘤1例（1个）,其他部位新动脉瘤形成7个,下肢血管移植物闭塞2例,但患肢无明显缺血坏死。6例患者随访3-293个月,随访中位时间28个月,1例死于肺癌。结论白塞病动脉瘤一旦发生,需积极处理。术前、术后积极免疫抑制治疗可降低外科手术和腔内修复术后并发症发生。因术后有吻合口和其他部位假性动脉瘤复发及血管移植物闭塞可能,需长期随访、及时处理。     

The surgical treatment of arterial aneurysms in Behçet disease: a report of 16 patients

OBJECTIVE: The aim of this article is to report our experience in the surgical treatment of arterial aneurysms in patients with Beh?et disease. METHODS: From October 2001 through May 2004, 18 arterial aneurysms were diagnosed in 16 Beh?et patients. All patients were male. The patients ranged in age from 24 to 52 years (mean, 37.4 +/- 5.2 years). There were six abdominal aortic, three common femoral, two iliac, two popliteal, two superficial femoral, and two anterior tibial aneurysms and one subclavian artery aneurysm. All patients but four were in remission at the time of diagnosis. Those 4 patients received immunosuppressive therapy before the surgical intervention to induce remission. After hospital discharge, all patients were followed up regularly at 3-month intervals. The mean duration of follow-up was 17 +/- 4.2 months (range, 6-24 months). RESULTS: All patients underwent a successful surgical intervention. During the study period, we performed five aortic tube graft interpositions, two aortofemoral bypasses, one aortobifemoral bypass, three common femoral artery graft interpositions, and two femoropopliteal bypasses. The popliteal artery (n = 2), anterior tibial artery (n = 2), and subclavian artery (n = 1) aneurysms were repaired primarily. There was no in-hospital mortality. One patient with an abdominal aortic aneurysm had to undergo reoperation because of postoperative bleeding. The postoperative hospital stay was 8.5 +/- 4.3 days. Two patients were lost to follow-up. During the follow-up period, two false aneurysms of the common femoral artery were repaired with a graft interposition procedure. Another patient who had undergone an aortic tube graft interposition was readmitted 9 months later with an external iliac artery aneurysm. The external iliac artery was ligated through a retroperitoneal approach, and femorofemoral bypass was performed. In addition, one femoropopliteal interposition graft was occluded, without disabling ischemia. CONCLUSIONS: Although aneurysmal disease is rare in Beh?et disease, it can complicate the clinical picture and cause life-threatening complications. We believe that the establishment of remission before the surgical intervention decreases the incidence of postoperative complications. Because recurrence at the site of anastomosis is possible, prolonged monitoring is required.     

杂交技术治疗主动脉弓降部病变的临床研究

目的:探讨杂交技术治疗主动脉弓降部病变的效果。方法:采用杂交技术(解剖外旁路联合血管腔内修复术)手术治疗10例患者,包括累及主动脉弓部分支的B型主动脉夹层4例和主动脉弓降部真性动脉瘤6例。其中左颈总动脉至左椎动脉旁路1例,右颈总动脉至左颈总动脉旁路5例,右颈总动脉至左颈总动脉及左颈总动脉至左锁骨下动脉旁路1例和升主动脉至无名动脉及左颈总动脉旁路3例。均经股动脉入路植入覆膜支架。结果:10例患者均获得技术成功,1例发生少量I型内漏,未处理。术后1例因脑梗塞伴肺炎、肾功能衰竭不治自动出院;其余9例均痊愈出院。9例随访时间3～33个月,均恢复正常生活,术后3个月CTA示:覆膜支架无移位,1例内漏已消失,无新的内漏发生,夹层假腔或动脉瘤腔内已有血栓形成,远端夹层假腔无明显扩大,旁路人工血管通畅。结论:杂交手术避免体外循环损害,减轻外科手术创伤,提高了治疗效果,是治疗累及分支的主动脉弓降部病变的重要方法。     

腔内隔绝术治疗胸、腹主动脉瘤5例

目的 研究腔内隔绝术治疗胸、腹主动脉瘤的方法以及评价其效果。方法 2000年10月-2002年8月共开展腔内隔绝术5例，其中包括胸腹主动脉夹层动脉瘤4例，腹主动脉瘤1例。结果 5例动脉瘤腔内隔绝手术均获得成功，4例夹层动脉瘤的假腔立刻消失，1例腹主动脉瘤瘤体成功隔绝31例术后并发脑梗塞，经非手术治疗好转。结论 腔内隔绝术治疗大动脉瘤具有创伤少、安全、效果确切等优点。在严格选择适应证的基础上，开展腔内隔绝术是有价值的。     

腔内修复术在复杂型肾下腹主动脉瘤中的应用

目的:探讨对于复杂型肾下腹主动脉瘤(AAA)行腔内修复(EVAR)治疗的操作要点和治疗效果。方法:回顾行EVAR治疗的15例复杂型肾下AAA患者的临床资料,分析术中操作要点和临床结局。结果:手术技术成功率为100%,无中转开腹病例,1例(6.67%)术后5 d死于急性心衰。瘤颈成角过大2例患者均使用肱-股双导丝技术完成手术;髂动脉狭窄患者7例,4例利用肱-股双导丝技术及球囊扩张后置入支架,其余经球囊扩张完成操作;1例左髂动脉闭塞的患者采用对侧髂动脉进入导丝通过闭塞段完成手术;8例重度扭曲患者通过超硬导丝将扭曲段纠正后释放支架。术中无瘤体破裂、血管穿孔及医源性血管夹层等严重并发症出现。随访期间,1例患者术后2年出现腰椎结核,死于多脏器功能衰竭;内漏3例,二次手术干预1例。结论:随着经验的积累,技术的进步及支架的不断完善,EVAR治疗复杂型肾下AAA是可行、有效的。     

Endovascular repair of a common iliac artery aneurysm using the Cook Zenith abdominal aortic aneurysm Endovascular Graft Converter

Isolated common iliac artery aneurysm is a rare condition that is treated aggressively because of its high risk of rupture. Endovascular abdominal aortic aneurysm (AAA) repair has recently been extended to the clinical management of the iliac artery aneurysm. Stent grafts have been used successfully to exclude iliac artery aneurysms. Successful graft deployment and aneurysm exclusion require adequate seal and fixation at the proximal and distal attachment sites. This article presents a high-risk surgical patient whose 6.8-cm-diameter iliac artery aneurysm was repaired with a Zenith AAA Endovascular Graft Converter (Cook, Bloomington, Indiana). This device is normally used to convert an aortobiiliac endograft to an aortouniiliac endograft during AAA repair. The tapered 80-mm-long graft has diameters of 24 mm proximally and 12 mm distally. Completion arteriogram demonstrated exclusion of the iliac artery aneurysm with no evidence of endoleak. No postoperative complications occurred. No endoleak was seen on the follow-up abdominal computed tomography scan.     

Early and mid-term results of endovascular treatment of thoracic aorta diseases: a single-center experience

We conducted an analysis to assess early and mid-term outcomes of patients after thoracic endovascular aortic repair (TEVAR) for type B thoracic aorta dissection, descending thoracic aneurysm, or traumatic aortic transection. From January 2016 through December 2018, twenty-seven patients (23 male, 4 female, mean age of 57 years) affected by type B dissection (n = 13 [48.2%]), thoracic aneurysm (n = 9 [33.3%]), and post-traumatic aortic isthmus rupture (n = 5 [18.5%]) were treated using TEVAR with and without left subclavian artery revascularization. All procedures were performed in a hybrid operating room using general (n = 12) or regional (n = 15) anesthesia. A combined brachial artery and bilateral femoral artery access was used in all patients. To achieve adequate proximal thoracic aorta landing zone length, coverage of the left subclavian artery with proximal endovascular plug occlusion was performed in 17 patients (62.9%); including 4 patients undergoing carotid–subclavian artery bypass before TEVAR stent-graft deployment. Primary procedural success rate was 96.3%; 1 patient had a Type Ib endoleak that was treated by distal stent graft extension. Four adverse outcomes occurred in the immediate postoperative period, including 2 cases of left upper arm acute ischemia (7.4%), ischemic stroke (3.7%), and asymptomatic iliac artery dissection (3.7%). During a mean follow-up of 18 months, no graft-related deaths or endoleak occurred. One patient developed symptomatic subclavian steal syndrome 1 month after operation and underwent a left carotid–subclavian artery bypass with symptom resolution. One patient died 6 months after TEVAR due to neoplasm. Our experience indicates TEVAR is a safe and less invasive alternative to open surgery for a spectrum of thoracic aorta diseases, especially for urgent conditions and in patients with high-risk surgical comorbidities.