腔内隔绝术治疗腹主动脉瘤

目的探讨腹主动脉瘤（ＡＡＡ）腔内隔绝术的手术指征、手术方法、操作要点和存在的问题。方法１例高龄男性和多病并存的ＡＡＡ患者在全麻和选择性动脉造影动态监控下,用１１．０ｃｍ×２．６ｃｍ的内支撑－涤纶血管复合体,对ＡＡＡ进行了腔内隔绝术。结果术后１周和２０天分别行彩超和螺旋ＣＴ复查显示：复合体内径为２．２～２．４ｃｍ,通畅,无移位和扭曲。复合体壁外原ＡＡＡ腔内充满血栓,未探及通畅的腰动脉和肠系膜下动脉,ＡＡＡ外径无变化。复合体近端与ＡＡＡ颈前壁之间有一微裂隙,但对ＡＡＡ体影响不大。随访６个月,患者腹部搏动性肿块及左下肢间歇性跛行消失。结论ＡＡＡ腔内隔绝术避免了传统ＡＡＡ手术的各种缺点,而具简便、微创和疗效确实的优点,有良好的应用价值。     

腔内隔绝术治疗腹主动脉瘤

目的 探讨血管腔内隔绝术(EVE)成功的因素。方法6例患者行EVE治疗，5例用普通内支架置入术，1例应用肱股导丝牵张技术。结果6例EVE治疗过程顺利。6例近期疗效显著，无相关并发症发生。结论术前精确测量相关参数，选择大小及类型适当的支架及肱股导丝牵张技术是EVE成功的重要因素。     

针对腔内隔绝术的腹主动脉瘤分型探讨

我们在积累了一定的临床经验的基础上总结了针对腔内隔绝术(ＥＶＥ)的腹主动脉瘤(ＡＡＡ)分型。资料与方法1.一般资料:1997年3月以来我院共进行了肾下ＡＡＡ的ＥＶＥ52例。术前评估以螺旋ＣＴ为主[1],辅以ＭＲＡ。2.测量参数:测量参数主要有:远近端瘤颈、瘤体、髂总动脉的内径、长度,瘤体的最大外径,髂外动脉的内径。3.分型方法:根据远近端瘤颈长度分为3型,以罗马数字Ⅰ、Ⅱ、Ⅲ表示。Ⅰ型定义为近端瘤颈(瘤体上缘至肾动脉开口水平)长度大于或等于15ｍｍ,远端瘤颈(瘤体下缘至主动脉分叉)的长度大于或等于10ｍｍ。Ⅱ型为近端瘤颈长度大于或等…     

腔内隔绝术治疗腹主动脉瘤--3例报告

目的　探讨腹主动脉瘤腔内隔绝术适应证的选择及并发症的防治。　方法　采用经股动脉将支架 -人造血管复合移植物导入腹主动脉治疗腹主动脉瘤。　结果　手术操作均获成功。无并发症发生。　结论　腔内隔绝术治疗腹主动脉瘤具有简捷、微创、并发症少、术后恢复快等优点。     

腔内隔绝术治疗腹主动脉瘤1例的护理

随着人们生活水平的提高和平均寿命的延长 ,以动脉硬化为病因的腹主动脉瘤 (abdominal aorticaneurysm,AAA)逐年增加。传统的手术方式为瘤体切除、人工血管置换术 ,其手术时间长、创伤大、病死率高。近年来在腔内血管外科技术基础上又发展了腔内隔绝术治疗 AAA。我院 2 0 0 1年 3月 3 1日完成西北地区首例 AAA腔内隔绝术 ,报道如下。1　病例介绍男 ,71岁。因发现腹部搏动性肿块 1年余入院。入院诊断腹主动脉瘤。既往有高血压病史十余年 ,血压 1 3 5 /75～ 1 5 0 /98mm Hg(1 mm Hg=0 .1 3 3 k Pa) ;吸烟史近 5 0年。心电图检查提示心肌…     

腹主动脉瘤腔内隔绝术内漏处理进展

内漏是腹主动脉瘤腔内隔绝术常见的并发症,也是导致腔内隔绝术失败最主要的原因。本文综述了内漏形成的机制,结合作者单位的经验,讨论了术中内漏的处理方法,并在文献复习的基础上,对随访期内漏与动脉瘤发展之间的关系以及处理原则进行了探讨。     

腹主动脉瘤腔内隔绝术后内漏

腹主动脉瘤腔内隔绝术后内漏 (ｅｎｄｏｌｅａｋ)是腹主动脉瘤腔内治疗过程中所产生的并发症[1] 。腔内治疗的方法是在腹主动脉瘤腔内放置带膜的血管支架 ,用移植物将循环血流和动脉瘤囊相隔开 ,使动脉瘤不再承受到循环血流的冲击 ,不再承受动脉压的压力 ,腹主动脉瘤不再增大和破裂。如果经过腔内隔绝术后 ,移植物外层的动脉瘤囊内仍有循环血流进入或进出 ,说明动脉瘤未与循环系统完全隔开 ,动脉瘤继续扩大甚至发生破裂 ,导致腹主动脉瘤隔绝手术的失败[2 ,3] 。所有类型移植物的内漏率是 2 4% (12 4/ 5 2 3) ,即发性内漏率约为 17% (89/ 5 2…     

腹主动脉瘤腔内隔绝术与传统术式比较

治疗腹主动脉瘤(AAA)传统的手术方式为AAA人造血管内置术。目前逐步发展的是AAA腔内隔绝术。本通过两种术式的手术方法、临床应用和生物学反应的比较表明，AAA腔内隔绝术较传统手术最主要的优点是减少了创伤程度，避免了全麻，避免了剖腹术，避免了手术中主动脉的钳夹．避免了缺血再灌注后氧自由基、TNF-2、IL-1β、IL-6等的损伤。避免了手术后常见的心、肺、肾并发症，明显降低了术后见亡率，尤其使那些有严章并存病而不能耐受AAA切除的高危病人荻得了救治的希望。     

腹主动脉瘤患者腔内隔绝术后生化指标观察

目的：观察腹主动脉瘤患腔内隔绝术（EVGE）后生化指标的变化。方法：回顾性观察分析78例腹主动脉瘤患传统手术（OS）及EVGE后血清总蛋白,白蛋白,球蛋白,肌酐,尿素氮水平的改变情况。结果：两组术前上述指标均无显性差别。术后OS组总蛋白,白蛋白均有显下降,血肌酐及尿素氮均明显升高;球蛋白,总胆红素,间接胆红素无明显变化。EVGE组术后总蛋白,白蛋白,球蛋白及白球比值均明显下降,直接胆红素增加,总胆红素,间接胆红素,肌酐,尿素氮无明显变化。术后OS组较EVGE组白球比值明显下降（P＝0．0082）,BUN明显升高（P＝0．0497）。结论：EVGE对肝肾功能的影响小,是适合腹主动脉瘤患的微创疗法。     

腔内人造血管移植术治疗腹主动脉瘤

目的 评价腔内人造血管移植术治疗腹主动脉瘤早期临床疗效。方法 总结对14例腹主动脉瘤患者采用经腹股沟切口腹主动脉瘤腔内人造管移植术的经验。结果 12例选用分叉型腔内人造血管,2例选用直型腔内人造人管,术后即刻DSA造影显示动脉瘤消失,近远端人造血管与宿主动脉结合处均未见渗漏,11例患者术后生命体征平稳,1例术后24h出现小面积急性心肌梗塞,经溶栓和抗凝治疗后缓解,术后死亡2例,技术成功率85.7%。12例患者术后1周随访螺旋CT,其中有4例术后3个月、1例术后12个月再次做螺旋CT,显示人造血管无移位,2例有渗漏,但动脉瘤腔无增大。结论 腔内人造血管移植术是一种创伤小、恢复快的治疗腹主动脉瘤新方法,但远期疗效有待随访。     

Endovascular exclusion of saphenous vein graft aneurysms complicating abdominal aortic aneurysm repair--a case report

A 64-year-old man was referred for vascular evaluation before renal transplantation for ischemic nephropathy. In the past he had undergone bilateral renal artery revascularizations using saphenous vein. At the time of transplant evaluation, he was found to have bilateral aneurysms of the saphenous veins used to bypass his renal artery stenoses. He underwent successful endovascular exclusion of the aneurysms with 2 endovascular AneuRx extension cuffs. This case highlights both the versatility of endovascular treatments as well as the importance of a comprehensive vascular examination.     

Endovascular repair of infrarenal abdominal aortic aneurysms in high-risk-surgical patients.

PURPOSE: Following the publication of a prospective randomized trial (EVAR2) that questioned the benefit of endovascular repair of abdominal aortic aneurysms (AAA) for high-surgical-risk patients, we evaluated our own initial and long-term results with endovascular AAA repair for this patient population. MATERIAL AND METHODS: Between January 2000 and December 2005, 115 patients with an AAA managed by an aortic endograft were entered in a registry. Data concerning diagnosis, operative risk, treatment, and follow-up were analyzed on an intention-to-treat basis for all patients considered to be poor candidates for surgery. Patients with a ruptured AAA and those who were good surgical candidates were excluded from analysis. The main goal was evaluation of the operative mortality and the long-term survival of these patients. Secondary goals were determination of the frequency of secondary operations, the outcome of the aneurysm sac, and primary and secondary patency rates after aortic endograft placement. RESULTS: A total of 92 high-surgical-risk patients treated by an endograft were entered in this study. Sixty-seven patients (73%) were classed ASA III and 18 (20%) were ASA IV (20%). Mean aneurysm diameter was 58 mm+/-9 mm. The technical success rate was 99%. Operative mortality was 4.3% (4 cases). Four patients required re-intervention during the mean follow-up of 18 months. The survival rate at 3 yr was 85%. One type I endoleak (1%) and 9 type II endoleaks (9.7%) occurred during the follow-up period. Primary and secondary patency rates at 3 yr were respectively 96% and 100%. CONCLUSION: Our initial and long-term results with endograft repair of AAA in high-surgical-risk patients were satisfactory. These results appear to justify endovascular repair for this patient population.     

肾动脉下腹主动脉瘤腔内修复术42例分析

目的 探讨肾动脉下腹主动脉瘤腔内修复术的价值。方法 中山大学附属第一医院自2001年12月至2005年4月．共手术治疗42例肾动脉下腹主动脉瘤病人。采用单侧或双侧股动脉入路植入带膜支架对肾动脉下腹主动脉瘤进行腔内修复。结果42例肾动脉下腹主动脉瘤病人接受了血管腔内修复术，手术全部成功。围手术期死亡2例，其中1例为术前腹主动脉瘤破裂休克时间较长，已经合并急性肾功能不全；另1例为术后出现脑血管意外，2例均在术后3d死亡。其余40例随访1-40个月，全部存活。结论 肾动脉下腹主动脉瘤腔内修复术是一种安全、有效的治疗方法，长期疗效仍有待进一步观察。     

腔内隔绝术治疗腹主动脉瘤(附5例报告)

目的探讨腹主动脉瘤腔内隔绝术的适应症及其并发症的防治。方法对5例患者采用经股动脉植入支架-人造血管复合移植物,对腹主动脉瘤进行腔内隔绝术。结果5例手术均获成功,无任何并发症发生。结论腔内隔绝术治疗腹主动脉瘤具有简捷、微创、并发症少、术后恢复快等优点,为治疗本病的首选方法。     

Endovascular stent graft selection for the treatment of abdominal aortic aneurysms

Minimally invasive endovascular techniques for the treatment of abdominal aortic aneurysms (AAA) have significantly reduced the morbidity of these procedures as compared with standard surgical repair. In addition, patients with extensive comorbid medical illnesses in whom standard operative repair is contra-indicated, may be successfully treated using endovascular means. A variety of endovascular stent grafts are currently being used clinically for endovascular AAA repair. The characteristics of these stent grafts vary significantly. In selecting the specific stent graft to be used for endovascular AAA repair, these specific characteristics must be considered particularly with regard to the individual patient's anatomic and physiologic characteristics. The United States Food and Drug Administration (FDA) has approved 4 endovascular stent grafts for the treatment of AAA: the Medtronic AneuRx, the W. L. Gore Excluder, the Cook Zenith and the Guidant Ancure. The Zenith graft received approval for marketing in 2003 and has gained relatively wide usage, in part due to its ability to treat aneurysms with relatively large diameter implantations zones. Also in 2003 the Guidant Corporation withdrew the Ancure graft from marketing and distribution. Enrollment has also been recently completed for the phase II FDA trials of the Medtronic Talent graft and the Cordis Fortron graft. These devices have been approved for use in the European Union and are awaiting FDA panel meeting in the United States. Comparative analysis of several of the available stent grafts has been performed. Results have varied with regard to the need for secondary interventions, aneurysm sac size reduction and the occurrence of continued perfusion of the aneurysm sac. Several significant advances have also occurred recently in stent graft research and development. Of particular significance has been the initiation of the phase I trial of the Trivascular Enovus graft. Deployment of the Trivascular graft may be accomplished through a delivery system that is considerably reduced in profile. The potential for percutaneous application of the graft may be available in the future. The indications for use of endovascular grafts as compared to standard open surgery have not yet been fully defined. Endovascular stent grafts in current use have limitations and their use must be tempered accordingly, until their long-term effectiveness is more completely evaluated. This article describes the general principles of use for endovascular devices for the repair of AAAs. It details the features and results for the devices in current use and highlights the factors that influence the selection of specific stent graft types.     

Proximal abdominal aortic aneurysms after infrarenal aortic reconstruction

The failure of infrarenal aortic open reconstruction due to sterile sovranastomotic abdominal aortic aneurysm (SS-AAA) is a rare and complex long-term complication. Even if they undergo the same treatment, is necessary to distinguish between true aneurysmal degeneration of proximal aorta and chronic proximal aortic anastomosis sterile rupture with consequent false aneurysm formation: we call proximal para-anastomotic abdominal aortic aneurysm (PPA-AAA) the first and proximal anastomotic false abdominal aortic aneurysm (PAF-AAA) the latter. The etiology of this complication is exclusively degenerative and it occurs in the absence of infection, which has totally different features. SS-AAA have been reported in 1 to 4% patients, but the available studies differ about patient selection and diagnostic methods. According to these considerations we can suppose the real incidence greater and near to 25% in over 10 years follow-up patients. Clinical findings of PPA and PAF-AAA before rupture are poor and this consideration emphasizes the necessity of a long term ultrasound follow-up. Best diagnostic tools after echographic detection of SS-AAA are spiral TC scan and MR imaging. Due to image accuracy, the short time necessary to take the images and availability spiral TC has taken the place of standard TC and arteriography. Scar tissue field and visceral vessels involvement with consequent proximal clamping are the main problems in open repair of SS-AAA. Elective open repair mortality rate varies from 0 to 17% and increases dramatically after rupture. Endovascular repair at the present is suitable only for hardly selected cases, because of frequent visceral involvement. We report our 17 patients series (8 PPA and 9 PAF-AAA), which we have observed friom 1991 to 2003 in a total amount of 1363 abdominal aortic aneurysms treated. All the patients have been treated with elective open repair with a global perioperative mortality of 6% (1/17).     

Current management of infrarenal abdominal aortic aneurysms

Since the concept of endovascular aneurysm repair (EVAR) was introduced more than 15 years ago, many technological advances and multiple generations of aortic stent-graft devices have been used to manage infrarenal abdominal aortic aneurysms. In this rapidly changing environment, the determination of the optimal management of patients with aneurysmal disease can be difficult. In this article, the current management of infrarenal abdominal aortic aneurysms is outlined. Consistent data revealing short-term advantages in morbidity and mortality make EVAR a very appealing option for practitioners and patients. However, mid- and long-term data proving an all-cause mortality benefit are lacking. Open repair has proven durability, and should be strongly considered in younger and lower-risk patients.