肾动脉水平以下腹主动脉瘤的诊断和治疗(附261例报告)

为提高腹主动脉瘤手术的安全性，对１９６０年１月～１９９７年１２月２６１例肾动脉水平以下腹主动脉瘤的处理进行了分析。１９７０年以前手术切除７３例，其中５０例经主动脉造影确诊。１９８７年以来的１７８例由Ｂ超和ＣＴ确诊，５例行动脉造影或数字减影造影（ＤＳＡ）、５例经磁共振血管成像明确了动脉瘤上界和肾动脉的关系。结果：患者均行动脉瘤切除人造血管移植，手术死亡率３．８％，５年存活率７４．４１％。腹主动脉瘤诊断中最为关键的是确定动脉瘤上界与肾动脉间的距离，若Ｂ超与ＣＴ不能肯定，主动脉造影或ＤＳＡ极有帮助。提示：手术操作和麻醉技术的改进使腹主动脉瘤修补术变得更为迅速、安全和方便。     

肾动脉水平以下腹主动脉瘤外科治疗的若干问题(附461例报告)

提高肾动脉水平以下腹主动脉瘤手术的安全性。方法：总结１９６０年１月～２００１年３月４６１例腹主动脉瘤切除、人造血管移植及腹主动脉瘤腔内隔绝术的经验。结果：随着腹膜后途径和小切口等技术的应用,动脉瘤近端血流控制、动脉瘤切除以及缝合修补和腔内隔绝术等方法的更新,使手术危险性明显降低,手术死亡率４．８％,５年存活率达７４．４％。结论：手术技术和麻醉监护的进步,使腹主动脉瘤的外科治疗变得更安全、迅速和方便。     

肾动脉水平以下腹主动脉瘤237例的诊治研究

目的 提高肾动脉水平以下腹主动脉瘤手术的安全性。方法 回顾性总结２３７例肾动脉水平以下腹主动脉瘤的诊疗经验，结果 ２３７例均行动脉瘤切除，人造血管移植，手术死亡率３．８％，５年存活率７４．４１％，结论 诊断腹主动脉瘤的关键是确定动脉瘤上界与肾动脉间的距离，若Ｂ超与ＣＴ不能确诊，主动脉造影或数字减影造极有帮助，手术操作技术的改进使肾主动脉瘤修补变得更为安全，简便。     

外科治疗腹主动脉瘤482例

目的 探讨提高腹主动脉瘤手术安全性的方法。方法 总结了自1960年1月－2001年3月482例腹主动脉瘤切除人工血管移植以及腹主脉瘤腔内隔绝术的经验。本组461例肾动脉水平以下腹主动脉瘤,采用动脉瘤切除人工血管移植430例,31例采用腹主动脉瘤腔内隔绝术,21例胸、腹主动脉瘤采用Crawford方法切除。采用腹膜外途径21例,小切口15例,脐下弧形切口11例。结果 随着腹膜后途径及脐下弧形切口和小切口等应用,动脉瘤近端血流控制,动脉瘤切除以及缝合修补和腔内隔绝术等方法的更新,使手术的危险性明显降低,总手术病死率5．2％,5年存活率达74．4％。结论 手术技术和麻醉监护的进步,使腹主动脉瘤的外科治疗变得更安全、迅速和方便。     

178例肾动脉水平以下腹主动脉瘤手术治疗经验

自１９６０年１月至１９９４年１２月间我院施行肾动脉水平以下腹主动脉瘤切除人造血管移植术１７８例。其中男１４７例，女３１例，年龄１５￣８２岁，平均６５．５岁，合并高血压者１１８例（６６％），冠心病４０例（２３．０％）、糖尿病１７例（９．５％）。Ｂ型超声和ＣＴ有助于腹主动脉瘤的诊断。若Ｂ超与ＣＴ不能确定动脉瘤上界与肾动脉间的距离，主动脉造影或数字减影血管造影术（ＤＳＡ）极有帮助。手术操作术的改进使腹主     

腔内隔绝术治疗主动脉疾病:与传统手术比较

动脉瘤破裂的死亡率高。严重威胁病人的生命。在动脉瘤治疗的曲折道路上，临床医师尝试了多种手术治疗方法，有结扎法、腐蚀法、硬化剂注入法．后又由Moore插入金属丝导致血栓，及出现动脉瘤外包裹法等．但均以失败告终。从Alexis Canrrel成功完成了同种动静脉置换主动脉及吻合术．于1912年获诺贝尔奖。到1951年与Charles Duboat共同完成首例同种移植主动脉瘤手术．随后在1953年Bahnson成功完成第一例动脉瘤修补术至今，已有53年的历史。经过多年来的不断改进．腹主动脉瘤（AAA）手术的死亡率已由20年前的40％～50％降至5％以下。传统的腹主动脉瘤修补手术（OR）经受了长达50年历史的考验。为动脉瘤的治疗开创了成功之路。     

腹主动脉瘤的外科治疗

目的　提高腹主动脉瘤手术的安全性。方法　总结 196 0年 1月到 2 0 0 0年 3月 482例腹主动脉切除人造血管移植及腹主动脉瘤腔内隔绝术的经验。结果　随着腹膜后途径和小切口等的应用 ,动脉瘤近端血流控制、动脉瘤切除以及缝合修补和腔内隔绝术等方法的更新 ,使手术的危险性明显降低 ,总手术死亡率 5 .2 % ,5年存活率达 74.4%。结论　手术技术和麻醉监护的进步 ,使腹主动脉瘤的外科治疗变得更安全、迅速和方便     

腹主动脉瘤的外科治疗

自１９８１年至１９９４年，作者共收治包括４７例胸腹主动脉瘤在内的腹主动脉瘤患者１７８例。年龄自４岁至７９岁，平均５２．１岁。男女比例为５∶１。４例伴主动脉－上腔静脉瘘，２例腹主动脉－十二指肠瘘，１例伴由胃癌所致的幽门梗阻，６例由大动脉瘤。腹主动脉瘤采用常规手术方法。胸腹主动脉瘤用改良的ＢｅＢａｋｅｙ法、Ｃｒａｗｆｏｒｄ法或胸腹部病变分期切除法。腹主动脉瘤手术死亡率３．８％，胸腹主动脉瘤１７．４％。     

胸部主动脉瘤的外科治疗

作者自１９９０年４月至１９９４年１２月共收治了各类胸主动脉瘤８０例，其中进行手术治疗共６１例，分别为Ｂｅｎｔａｌ手术３５例，Ｗｈｅａｔ手术３例，主动脉峡部瘤切除术３例，降主动脉瘤人造血管置换术１４例，其他６例。总手术死亡率为６％。１９例非手术治疗组中，有８例于术前动脉瘤破裂，５例死亡，３例出院后其中２例半年后死亡。在有夹层形成的４９例中，Ａ型夹层动脉瘤２８例，Ｂ型夹层动脉瘤２１例（Ｓｔａｎｆｏｒｄ分类法）。手术成功的重要因素是预防术后大出血，心律失常和感染。     

腹主动脉瘤并存胃肠外科病变的处理

腹主动脉瘤（abdominalaorticaneury－sm,AAA）的发病近年呈上升趋势,随着医学进步,AAA切除已安全有效,但当AAA与需要手术治疗的胃肠病变同时存在时,对其行一期还是分期处理存在争议,是治疗的难题犤１－３犦。我们报道１５７例AAA中４例胃肠手术的体会。１．临床资料：１９９１年１月至２００１年８月,１５７例AAA行动脉瘤切除和人工血管移植术,其中４例伴发需要手术治疗的胃肠病变（２．５％）,均为男性,年龄６０～７８（７１．５±８．５）岁。分别是胃癌、升结肠癌、直肠癌和乙状结肠坏死（表１）。例１因AAA和双髂动…     

Dissecting aneurysm of the infrarenal abdominal aorta

The aim of this study was to report the case of a patient with chronic dissecting infrarenal abdominal aortic aneurysm (AAA) and to review the literature for this rare vascular disorder. The preoperative assessment, surgical treatment, and postoperative course of a patient with a dissecting AAA and associated left iliac artery dissection were analyzed. The literature is reviewed with respect to etiology and pathogenesis as well as diagnostic and therapeutic management of infrarenal dissecting AAA. The preoperative diagnosis of dissecting infrarenal AAA was made by computed tomography and aortography and confirmed during surgery. Successful repair was accomplished by use of a bifurcated aortobiiliacal Dacron graft. A review of the literature demonstrates the rarity of dissecting aneurysm exclusively involving the infrarenal aortic segment. Primary dissecting aneurysm of the infrarenal abdominal aorta is a rare morphologic finding. Principles of diagnostic and therapeutic management of common atherosclerotic AAA also apply to dissecting AAA.     

Endovascular Repair of a ruptured abdominal aortic and iliac artery aneurysm with an acute iliocaval fistula secondary to lymphoma

Abdominal aortic aneurysms (AAA) are common and generally asymptomatic unless rupture occurs. A 3 to 4-cm AAA has a 1-2% risk of rupture over 5 years. We present the case of an 85-year-old male with a history of chronic lymphocytic leukemia, a 3-cm infrarenal AAA, and a 2-cm right common iliac artery aneurysm whose AAA ruptured and who developed an acute iliac artery–to–vena cava fistula secondary to eroding adenopathy from an aggressive low-grade lymphoma. Initially, an open repair was attempted but access to the aorta was not possible because of complete encasement of the infrarenal and suprarenal aorta with tumor that was clinically invading the aortic wall. Secondary tumor invasion into the aorta is a rare complication. An endovascular repair was accomplished with successful exclusion of both the aneurysm and the iliocaval fistula. Endovascular repair provides a valuable alternative in the "hostile abdomen" when standard open repair may be hazardous or impossible.     

肾动脉下腹主动脉瘤腔内治疗后并发症的防治

目的　总结肾动脉下腹主动脉瘤腔内治疗后常见并发症的预防与处理。　方法对已施行腔内治疗的 71例肾下腹主动脉瘤患者的临床资料进行回顾性分析 ,讨论常见并发症发生的原因、处理、结果及预后。　结果　 71例接受腔内治疗的肾动脉下腹主动脉瘤患者技术成功率1 0 0 % ,无中转开腹手术者。原发性内漏 8例 ,神经并发症合并急性血栓形成 1例。一过性缺血性肠炎 2例。无肾动脉梗死、肢体栓塞等并发症。平均随访时间 (2 6± 5)个月。围手术期病死率 1 3 % (1 /71 ) ,总病死率 4 2 % (3/ 71 )。死亡原因 2例为急性心肌梗死 ,1例为急性心功能衰竭。随访过程中发现 3例原发性内漏转为持续性内漏 ,另发现继发性内漏 4例。本组患者 1个月后内漏发生率 9 8%(7/ 71 )。 2例继发性Ⅰ型内漏随访中瘤体增大 ,1例进行二期腔内治疗。　结论　动脉瘤的腔内治疗具有创伤小、技术操作可行、效果肯定的优点 ,内漏血是该技术主要并发症。对漏血量及瘤体有增大趋势的内漏应积极处理     

An Abdominal Aortic Aneurysm in an 8-Month-Old Girl with Tuberous Sclerosis

The association between an abdominal aortic aneurysm (AAA) and tuberous sclerosis (TS) is rare. An 8-month-old girl presented with a seizure, and the clinical evaluation revealed TS. An abdominal evaluation showed a 3-cm infrarenal AAA. A normal diameter of infrarenal aorta for an 8-month-old girl is about 6 mm. The patient underwent an open repair with a polytetrafluoroethylene (PTFE) prosthesis. The pathology showed a loss of elastin fibres in the media of the aorta. The graft was patent on computed tomography (CT) angiography, performed 4 months after the operation. However, the patient died of complications related to seizures 5 years after the surgery. The graft remained patent until the time of death.     

A single-stage operation for abdominal aortic aneurysm with concomitant colorectal carcinoma.

The coexistence of abdominal aortic aneurysm (AAA) and colorectal carcinoma needs special operative consideration. A single-stage operation for concomitant AAA and colorectal carcinoma has been thought to increase the risk of vascular prosthetic graft infection. We report two patients who received a single-stage operation for AAA and colorectal carcinoma. The first patient had a fusiform aneurysm of the infrarenal aorta. The second patient had a saccular aneurysm of the infrarenal aorta and a fusiform aneurysm of the left internal iliac artery. Both patients had left-sided colorectal carcinoma classified as Dukes' stage B. The two patients underwent a single-stage operation with Hartmann's procedure to avoid graft infection caused by anastomotic leakage. They tolerated the operation and had no postoperative complications including graft infection. A single-stage operation for concomitant AAA and left-sided colorectal carcinoma could be safely performed with Hartmann's procedure in two cases.     

Changes of the Infrarenal Aortic Segment After Conventional Abdominal Aortic Aneurysm Repair

OBJECTIVES: to delineate the natural history of the residual infrarenal aortic segment after conventional abdominal aortic aneurysm (AAA) repair. DESIGN: open prospective study. PATIENTS AND METHODS: between 1990 and 1997, 100 patients, who underwent conventional infrarenal AAA repair at our department, were followed annually by means of colour duplex ultrasonography. Data from 76 patients who had at least 3 scans were analysed. RESULTS: mean duration of follow-up was 4.7 years (range: 3-8 years). The residual infrarenal aorta dilated a mean of 0.57 mm annually. No patient required reoperation. There was no significant correlation between dilatation and any of the recorded risk factors except for the initial neck diameter (p=0.03). CONCLUSIONS: conventional AAA surgery is durable so that surveillance, during the first 5 postoperative years, is not justified in terms of cost-effectiveness. The impact of such a dilatation on endovascular AAA repair requires further investigation.     

Computed tomography-detected abnormalities following conventional abdominal aortic aneurysm (AAA) repair

PURPOSE: To determine how time since the operation influences vascular abnormalities following conventional infrarenal abdominal aortic aneurysm (AAA) repair.METHODS: In 47 patients computed tomography was performed 1 to 12 years following the aneurysm repair. Aortic diameters at different levels were measured and other abnormalities recorded.RESULTS: Significant correlation was found between time since operation and diameter of the suprarenal aorta (R=0.51, P<0.001) but not with aortic neck diameter (R=-0.10, P=0.48) or diameter of the prosthetic graft (R=0.07, P=0.66). However, measured diameters of graft and aortic neck showed a significant positive correlation (R=0.40, P=0.005).CONCLUSIONS: Dilatation of the suprarenal aorta has a different pattern from aortic neck dilatation. The latter showed correlation with the diameter of the prosthetic graft. This may be of interest for future design of endovascular stent-grafts.     

Blood loss and transfusion in elective abdominal aortic aneurysm surgery

BACKGROUND: Intraoperative blood loss and transfusion are known determinants of mortality and morbidity of elective abdominal aortic aneurysm (AAA) repair. The present study analysed the pattern of blood loss and transfusion and evaluated the risk factors of blood loss during open repair of infrarenal AAA. METHODS: Blood loss, transfusion and fluid replacement during elective open repair operation for patients with infrarenal AAA were correlated to demographic data, operative findings and procedural information. RESULTS: A total of 129 patients with a mean age of 71 years was analysed. The mean blood loss was 1000 +/- 887 mL (200-6000 mL). Blood transfusion, with a mean transfusion volume of 400 +/- 591 mL (0-3000 mL), was required in 46% of patients. Univariate analysis showed that bodyweight, renal impairment, low haemoglobin and platelet counts, iliac artery involvement, large aneurysm, bifurcated graft, large graft diameter, prolonged aortic clamp time and long operation time were associated with a higher blood loss. A haemoglobin level of <10.5 g/dL (relative risk (RR): 4.6), platelet count <130 x 10(9)/L (RR: 3.9), aortic clamp time >50 min (RR: 15), total operation time >200 min (RR: 11) and type of graft (RR: 3.5) were identified as independent determinants of blood loss on multivariate analysis. CONCLUSION: Intraoperative blood loss in elective infrarenal aneurysm surgery is influenced by patients' haematological parameters, distal involvement of aneurysm and degree of difficulty of operation.     

Simultaneous abdominal aortic aneurysm repair during the on-pump coronary artery bypass grafting.

A case of simultaneous coronary artery bypass grafting (CABG) and abdominal aortic aneurysm (AAA) repair on cardiopulmonary bypass (CPB) is reported. A 74-year-old man was diagnosed with left main coronary disease and infrarenal AAA. Triple CABG and infrarenal AAA repair were performed simultaneously, by different surgeons, on CPB. The duration of CPB, aortic clamp time, and total operation time was 81 min, 33 min, and 245 min, respectively. The patient was extubated three hours after ICU admission and the postoperative course was uneventful. This method is useful for reduction of operation time, for blood salvage, and for adjustment of preload and afterload of the vulnerable heart during AAA repair.