复杂瘤颈的近肾腹主动脉瘤腔内修复中烟囱技术的应用

目的探讨瘤颈解剖复杂的近肾腹主动脉瘤(juxtarenal aortic aneurysms,JAA)腔内修复(endovascular aneurysmrepair,EVAR)中应用烟囱技术的价值。方法 2007年1月～2011年10月,对7例瘤颈复杂的JAA采用EVAR治疗。由于瘤颈解剖结构不适于标准的腔内修复方案,术中自肱动脉穿刺预先于可能被覆膜支架主体覆盖的肾动脉置入导丝,置入修复腹主动脉瘤的覆膜支架主体后造影明确肾动脉覆盖情况,于相应肾动脉置入自膨支架或球囊扩张支架,以延长瘤颈长度使之符合EVAR要求,并有效保护肾动脉(即烟囱技术),然后再完成标准EVAR操作。结果 7例手术全部获成功。7例使用9枚肾动脉支架,其中5枚球扩支架,4枚自膨支架。腔内治疗最后的造影显示:腹主动脉瘤(abdominal aortic aneurysm,AAA)瘤腔隔绝良好,肾动脉血流良好。术中1例近端Ⅰ型内漏,近端增加Cuff后内漏消失;1例造影显示少量的Ⅱ型内漏,无须处理。7例随访1～52个月,平均11.6月:1例术后2个月因心功能衰竭死亡;1例Ⅱ型内漏术后3个月随访内漏消失;肾动脉烟囱支架均保持通畅。结论对于不适宜行开腹手术治疗的瘤颈解剖不佳的JAA,烟囱技术是传统EVAR技术的有效补充,远期效果及肾动脉支架长期通畅性尚需要进一步观察。     

高危复杂腹主动脉瘤腔内修复术临床分析

目的 评估应用多种腔内技术治疗高危复杂腹主动脉瘤的可行性.方法 2001年1月至2010年12月,共138例腹主动脉瘤患者接受腹主动脉腔内修复术(EVAR),其中9例患者为高危复杂性腹主动脉瘤.男性8例,女性1例,年龄26～87岁,平均67岁.其中2例近肾腹主动脉假性动脉瘤,5例近肾腹主动脉瘤,1例腹主动脉瘤合并双髂总动脉瘤及左侧髂内动脉瘤,1例EVAR术后右髂内动脉瘤.所采用的腔内技术包括:主动脉支架开窗技术和扇形技术2例,烟囱技术5例,球囊辅助下髂内动脉瘤腔内治疗1例和球囊辅助反转支架技术1例.结果 所有腔内技术均获得成功.术中支架释放后即刻发现内漏4例,其中1例患者为Ⅰ型和Ⅲ型内漏,经大动脉球囊扩张后内漏消失;2例Ⅰ型内漏,其中1例行弹簧栓栓塞成功,另1例行近端裸支架成功.1例Ⅱ型内漏,经随访瘤腔直径未增大,未处理.随访4～79个月,平均25.9个月.无动脉瘤破裂,动脉瘤瘤体直径均有不同程度的缩小.随访过程中7例患者的靶血管(肾动脉、肠系膜上动脉和髂内动脉)均保持通畅.1例髂内动脉重建支架术后18个月血栓形成,但无盆腔缺血等症状.结论 对于不能耐受手术的高危复杂腹主动脉瘤患者,选择合适的腔内技术可以增加EVAR术的成功率,近、中期效果满意.     

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。     

复杂腹主动脉瘤腔内修复65例经验北大核心CSCD

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。     

“烟囱”技术在Ⅲ型夹层动脉瘤和腹主动脉瘤腔内修复术中的应用

目的 总结“烟囱”技术在主动脉瘤腔内修复术中的应用体会和一期效果.方法 在30例主动脉瘤腔内修复术中使用“烟囱”技术增加近端覆膜支架锚定区,其中25例DebakeyⅢ型夹层动脉瘤使用“烟囱”支架保留左锁骨下动脉(23例)或左颈总动脉(3例),肾下腹主动脉瘤使用“烟囱”支架保留肾动脉(5例).结果 所有病例均顺利完成操作,放置“烟囱”支架的分支动脉术中造影均通畅.其中2例夹层动脉瘤(8％)和1例腹主动脉瘤残留(20％)少量Ⅰ型内漏,1例夹层动脉瘤左锁骨下动脉“烟囱”病例术后5d猝死,考虑为远侧破口所致夹层动脉瘤破裂.其余22例夹层动脉瘤和4例肾下腹主动脉瘤均无内漏.随访28例(90.3％),随访1～19个月,平均(6±5)个月.随访期超声或CTA示“烟囱”血管血流均通畅.1例腹主动脉瘤仍有内漏,2例夹层内漏病例随访中(尚未行CTA),其他病例瘤腔血栓形成.结论 “烟囱”技术能够有效的延长覆膜支架在主动脉瘤腔内修复术中的近端锚定区并保持重要分支动脉通畅.     

瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏的疗效分析

目的总结瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏的疗效。方法回顾性分析2019年6月至2022年4月北京大学人民医院10例行瘤颈捆扎手术患者的临床及随访资料。结果手术指征为术后持续Ⅰ型内漏6例、Ⅱ型内漏3例、存在内张力1例, 均合并动脉瘤增大或破裂。全麻下经腹入路套带控制肾下近端瘤颈后使用捆扎带进行加固。10例患者均获得手术成功, 无内漏残留, 无支架移植物闭塞。围手术期并发症包括1例伤口愈合延迟和1例不完全性肠梗阻, 无围手术期死亡。中位随访时间13个月, 未发现内漏复发。1例患者术后6个月因胸降主动脉瘤接受胸主动脉瘤腔内修复术;无其他主动脉相关二次手术或主动脉相关死亡。结论瘤颈捆扎治疗腹主动脉瘤腔内修复术后持续内漏相对微创, 可以有效消除内漏。     

肾下腹主动脉瘤近端瘤颈形态与ⅠA型内漏的相关性研究

目的探讨腹主动脉瘤近端瘤颈的形态对ⅠA型内漏发生的影响。方法 2007年9月至2014年2月期间我院对收治的111例非破裂肾下腹主动脉瘤患者行腔内修复术,所有患者术前均行腹部动脉CT血管造影(CTA)检查,利用Osorix软件将所获得的CTA图像进行三维重建及测量,术后第3、6、12个月及以后每年复查,分析腹主动脉瘤近端瘤颈形态的相关指标与ⅠA型内漏发生的关系。结果本组有14例发生ⅠA型内漏,单因素分析结果显示,近肾动脉段瘤颈的直径变化率、近瘤体段瘤颈的变化率、近端瘤颈长度、附壁血栓及钙化与ⅠA型内漏的发生无关(P0.05),而近端瘤颈夹角和瘤体最大直径与ⅠA型内漏的发生有关(P=0.04,P=0.04);进一步多因素logistic分析结果显示,仅近端瘤颈夹角与ⅠA型内漏有关(P=0.002)。采用不同公司的支架对ⅠA型内漏的发生率比较差异亦无统计学意义(P0.05)。结论从本研究结果初步得出,形态复杂的近端瘤颈是影响ⅠA型内漏发生的重要原因,其中近端瘤颈夹角是独立影响因素,腔内修复术是否适用于治疗非破裂肾下腹主动脉瘤在很大程度上取决于近端瘤颈的形态。     

新型覆膜支架在腹主动脉瘤腔内修复中的应用

目的 总结腹主动脉瘤腔内修复术使用Endurant支架的经验及体会.方法 回顾分析2010年5月至2011年5月北京协和医院血管外科收治的19例肾下腹主动脉瘤使用Endurant支架行腔内修复术的病例特点、术后并发症和近期随访结果.结果 19例患者均获得手术成功,其中9例为复杂解剖形态的病例.术中同时进行的肾动脉支架、髂内动脉栓塞和髂动脉扩张也均获得成功.术后无Ⅰ、Ⅲ和Ⅳ型内漏发生,4例残余Ⅱ型内漏留待观察.围手术期无死亡病例,30 d并发症主要包括血栓消耗性凝血功能障碍,心肌梗死合并心衰,伤口感染和血肿.全组随访1～12个月,无死亡病例.8例患者完成至少1次CT动脉重建(computer tomography angiography,CTA)检查,5例动脉瘤体直径缩小,3例无改变.1例患者出现单侧髂腿延长支闭塞,行股股动脉转流.1例患者出现继发性ⅠB型内漏,继续观察.结论 腹主动脉瘤腔内修复术使用Endurant支架安全,有效.Endurant支架增加了对于复杂解剖形态的病例的手术成功率,近期疗效满意.     

近肾腹主动脉瘤的腔内治疗技术进展

腹主动脉瘤腔内修复术目前已成为大部分肾下型腹主动脉瘤患者的首选治疗,但对于近端瘤颈较短的近肾腹主动脉瘤,需要涉及内脏分支重建,常规的腹主动脉瘤腔内修复术疗效并不满意。近年来,烟囱支架技术、开窗支架技术、分支支架技术、八爪鱼技术等创新性技术的使用为近肾腹主动脉瘤患者的腔内治疗提供了多种解决方案,本文回顾并总结当前腔内治疗技术的进展,以期对目前各种技术的应用难点加以分析思考。     

粘合剂联合腔内修补治疗复杂瘤颈腹主动脉瘤9例报告

目的探讨纤维蛋白粘合剂瘤腔内注射联合腔内修补术治疗复杂瘤颈腹主动脉瘤的疗效。方法回顾性分析2017年7月～2018年3月应用纤维蛋白粘合剂瘤腔内注射联合腔内修补术治疗9例复杂瘤颈腹主动脉瘤的临床资料。其中短瘤颈(≤1 cm) 2例,瘤颈扭曲(角度 60°) 8例,桶状瘤颈2例,严重钙化2例,附壁血栓1例。结果 9例均完成手术,其中1例术中出现Ⅰ型内漏,密切随访2个月,内漏消失,无需手术干预;其他8例随访3～12个月,平均7. 2月,未见内漏、支架移位、感染及异位栓塞等并发症。结论纤维蛋白粘合剂瘤腔内注射联合腔内修补术治疗复杂瘤颈腹主动脉瘤是安全、有效的。     

Abdominal aortic endograft proximal collapse resulting in aortic aneurysm rupture

An 82-year-old man was transferred to our emergency department due to acute abdominal pain. He had undergone an endovascular abdominal aortic aneurysm repair (EVAR) six years ago. An intravenous contrast-enhanced abdominal computed tomography revealed the rupture of the abdominal aortic aneurysm (AAA) with a large retroperitoneal hematoma. A Talent (Medtronic, Santa Rosa, CA, USA) modular bifurcated endoprosthesis had vertically collapsed approximately 7 cm after losing its infrarenal fixation. As a result, it led to the repressurization of the aneurysm sac and rupture. The patient was successfully treated by placing three Talent (Medtronic) aortic cuffs. To our knowledge, this is the first reported case of endograft collapse that has manifested with aortic aneurysm rupture. Although they are gradually declining, considerable rates of complications create the 'Achilles' heel' of endovascular repair of AAAs. A lifelong follow-up strategy for patients treated for AAA with EVAR is essential for the early detection and treatment of complications of the procedure.     

腹主动脉瘤腔内治疗81例临床分析

目的 评估腔内修复术(EVAR)治疗腹主动脉瘤(AAA)的疗效及安全性,并比较不同年龄阶段患者的预后情况.方法 回顾性分析2005年5月到2011年5月接受EVAR的81例AAA 患者的住院和随访资料,将所有患者划分为高龄组(年龄≥75岁)和相对低龄组(年龄＜75岁),分别为24例和57例.对两组患者的一般状况、合并症、手术情况、院内并发症和随访等资料进行对比.结果 所有覆膜支架均顺利植入,技术成功率91.4％ (74/81).术中无死亡病例,住院病死率1.2％( 1/81).74例获得随访,随访率91.4％,平均随访47.5个月.随访期间死亡12例,1、2、3、4和5年生存率分别为98.6％、92.2％、80.8％、58.7％和44.1％.与相对低龄组比较,高龄组出现腹部疼痛症状比例较低,而合并肾脏疾病和冠状动脉粥样硬化性心脏病比例较高,术后重症监护时间较长,内漏发生率明显增加,而肺部感染和穿刺点血肿发生率也有增高趋势,其余住院及随访情况则无明显差异.结论 EVAR治疗AAA创伤小,安全,短中期疗效满意.高龄患者接受EVAR治疗后部分并发症发生率更高,围手术期应充分准备和密切观察,更好地防治可能的并发症,进一步改善预后.     

Endovascular aneurysm repair with a bifurcated endovascular graft at a primary referral center: influence of experience, age, gender, and aneurysm size on suitability

OBJECTIVE: The purpose of this study was to assess the suitability for endovascular repair of abdominal aortic aneurysm (EVAR) in an unselected patient population. PATIENTS AND METHODS: Between February 1999 and May 2002 all consecutive patients with a nonemergent abdominal aortic aneurysm (AAA) were prospectively examined with contrast material-enhanced spiral computed tomography (CT). Those patients probably suitable for EVAR on the basis of CT findings underwent calibrated angiography. A panel of radiologists and vascular surgeons reviewed the clinical data and vascular anatomy, and decided on the appropriateness of EVAR with the bifurcated Zenith AAA endovascular graft. RESULTS: One hundred seven patients were included. Fifty-six patients (52%) had one or more contraindications for EVAR. Unsuitability was most frequently (88%) related to the proximal neck. Inadequate neck length was the most common specific reason. Inadequate iliac anatomy was the reason for unsuitability in 59% of patients. The rate of unsuitability decreased from 61% during the first half of the study to 40% during the second half (P =.03) Unsuitability was equal between men and women. Age and maximum diameter did not differ between candidates and noncandidates. CONCLUSION: Almost half (48%) of patients with an infrarenal AAA referred to a primary referral center are suitable for EVAR with the bifurcated Zenith AAA endovascular graft. Neck anatomy was the most frequent reason for rejection. Rate of suitability increased over time, probably as a result of increasing experience. Suitability was not influenced by gender, age, or aneurysm size.     

矫正性裸支架理念在治疗复杂主动脉疾病中的应用

目的探讨矫正性裸支架理念在复杂主动脉病变中应用价值。方法回顾分析接受腔内修复术联合矫正性裸支架治疗的13例复杂主动脉夹层及2例肾下腹主动脉瘤患者的资料。结果 13例主动脉夹层患者中,植入Valiant支架11例,Grikin支架2例;2例腹主动脉瘤患者均植入Zenith支架。对15例患者共植入矫正性裸支架19枚;主动脉夹层裸支架17枚,长度60~80mm,直径18~24mm;腹主动脉瘤裸支架2枚,长度均为60mm,直径分别为24mm和7mm。所有患者术后无严重并发症。15例中,14例完成随访,1例失访,随访期间无支架源性夹层或内漏发生及假性动脉瘤、髂支血栓形成。结论矫正性裸支架理念有助于拓宽主动脉病变腔内治疗的适应证,且安全、微创、近期疗效满意。     

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。     

腹主动脉瘤腔内修复术中特殊远端锚定区的处理策略

目的 探讨对腹主动脉瘤腔内修复术(EVAR)中特殊远端锚定区的评估及处理方法.方法 回顾性分析2007年1月至2010年12月应用EVAR治疗的66例复杂远端锚定区腹主动脉瘤患者的临床资料.其中男性45例,女性21例,年龄53～87岁,平均62岁.本组Ⅰ型及ⅡA型病例共20例,其中髂总或髂外动脉＞50％狭窄10例,髂总或髂外动脉严重扭曲者6例,合并以上情况者4例;双髂总合并髂内动脉瘤46例(单侧32例,双侧14例).支架血管移植物采用Medtronic 46例,COOK 14例,Microport 4例,Lifetech 2例.结果 平均手术时间90 min,术中移植物明显短缩22例(33.3％),Ⅱ型内漏18例(18/66,27.3％),Ⅲ型内漏5例(7.6％),髂支＞50％的狭窄2例(3.0％),同时合并Ⅱ、Ⅲ型内漏5例(7.6％),同时合并髂支狭窄及Ⅲ型内漏4例(6.1％).本组随访时间3～36个月,平均22个月,随访期间内移植物向远端移位2例(3.0％),移位均＜10 mm,髂支再狭窄(＞50％)2例,Ⅱ型内漏自行消失18例(18/23,78.3％),Ⅲ型内漏0例;死亡2例.结论 复杂远端锚定区增加了EVAR并发症发生率.熟悉移植物特性,合理应用处理策略,可提高EVAR技术成功率.     

应用国产整体式分叉型支架腔内治疗肾下型腹主动脉瘤

目的探讨应用国产整体式分叉型支架腔内治疗肾下型腹主动脉瘤的效果。方法回顾性分析2009年9月—2011年6月采用国产整体式分叉型支架腔内隔绝术治疗27例肾下型腹主动脉瘤患者的临床资料。结果 27例腹主动脉瘤腔内修复均获成功,术后随访2～20个月复查CTA,DSA证实:瘤体被完全隔绝,支架无移位、扭曲及内漏现象。结论应用国产整体式分叉型支架腔内治疗肾下型腹主动脉瘤安全有效,与分体式支架相比,其简便、经济、并发症少。     

Surveillance of small aortic aneurysms does not alter anatomic suitability for endovascular repair

OBJECTIVE: Small abdominal aortic aneurysms (AAAs; 4-5.4 cm) are more likely to be suitable for endovascular aneurysm repair (EVAR) than large aortic aneurysms (>5.5 cm). The purpose of this study was to determine whether small AAA growth is associated with the development of morphologic characteristics that decrease eligibility for EVAR. METHODS: We studied 54 patients who underwent 2 or more computed tomography scans with 3-dimensional reconstruction during surveillance of small AAAs. Morphologic aortic aneurysm features and changes were measured according to Society for Vascular Surgery reporting standards. Suitability for EVAR was determined by neck anatomy (diameter, length, and angulations), iliac artery morphology, and total aortic aneurysm angulation and tortuosity. RESULTS: The median age of the study cohort was 73 years (interquartile range [IQR], 65-77 years). The median follow-up period was 24 months (IQR, 15-36 months). The median small AAA diameter increased from 44.5 mm (IQR, 41-48 mm) to 48.9 mm (IQR, 45.7-52.0 mm). The median aortic neck diameter increased from 23.0 to 24.0 mm (P = .002), whereas median neck length decreased from 26.5 to 20.0 mm (P = .001). Aortic aneurysm median tortuosity index increased from 1.09 to 1.11 (P = .05). No significant changes in iliac artery morphology occurred. Overall, the anatomic suitability for endovascular repair did not significantly change during the study period (74% vs 69%; McNemar test; P = .25). CONCLUSIONS: Changes in aortic morphology are frequently associated with small AAA growth at mid-term follow-up, but such changes are minor and do not affect overall anatomic suitability for EVAR. These data reveal that continued surveillance of small AAAs does not threaten the window of opportunity for EVAR.     

Minimally invasive retrieval of a dislodged Wallstent endoprosthesis after an endovascular abdominal aortic aneurysm repair

Endovascular abdominal aortic aneurysm repair (EVAR) is being performed more frequently in patients with concomitant iliac artery occlusive disease. We report a case of a 70-year-old male status post angioplasty and stenting of bilateral iliac arteries for occlusive disease who subsequently underwent EVAR for a rapidly expanding abdominal aortic aneurysm (AAA). One month after the placement of the endograft, it was discovered that the previously placed Wallstent had been dislodged during the endovascular abdominal aortic aneurysm repair. Minimally invasive retrieval using an Amplatz Goose Neck Snare was successful in recovering the stent. This case underscores the danger of performing EVAR in the setting of prior iliac artery stenting and the potential complications that may ensue.     

Experience with endovascular grafts in the treatment of infrarenal aortic aneurysms associated with proximal aortic dissection

BACKGROUND: Chronic abdominal and thoracic aortic dissections often present with concomitant infrarenal aortic dilatation. We conducted a retrospective review of 6 patients treated with endovascular stent grafts for coexisting aortic dissection and infrarenal aneurysm. METHODS: Six patients with suprarenal aortic dissections and infrarenal aortic aneurysms (AAA) had their AAAs treated with endovascular grafts. Grafts were constructed of balloon expandable Palmaz stents and expanded polytetrafluoroethylene graft. The device was inserted transfemorally and deployed under fluoroscopy. RESULTS: Successfully primary AAA exclusion was achieved in 5 patients. One patient required a supplemental stent placed above the endograft and into the true lumen to seal the endoleak. No aneurysm has enlarged, and all remain thrombosed for 9 to 24 months (mean 20). One type III dissection enlarged 2 weeks after endograft insertion. One patient had uncomplicated cephalad fenestration of a dissection by the endograft. CONCLUSIONS: Endovascular grafts may be used to treat coexisting AAA and aortic dissection. Attention to the site or sites of reentry of a dissection is essential to insure full aortic aneurysm exclusion. The fate of a chronic aortic dissection cephalad to an endovascularly treated AAA is unclear and will require longer follow-up.