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。     

一体化分叉型支架在肾下型腹主动脉瘤腔内治疗中的应用

目的 探讨一体化支架在肾下型腹主动脉瘤治疗中的应用.方法回顾分析 2010 年3 月至 2013 年 2 月采用一体化支架腔内修复术治疗肾下型腹主动脉瘤15例,对其临床资料进行分析总结.结果 所有病例均腔内修复成功,术后随访3～36个月复查CTA,瘤体均被完全隔绝,支架位置良好,无移位、扭曲及内漏现象.结论 术前准确评估、测量后,一体化支架治疗肾下性腹主动脉瘤效果良好,安全性高,操作简单并发症少.     

国产血管内裸支架介入治疗假性腹主动脉瘤的研究

目的 探讨国产血管内支架对假性腹主动脉瘤的治疗作用。方法 健康杂种犬32条均分为4组（组Ⅰ-Ⅳ）,对照组为组I,实验组按腹主动脉前壁切开长度不同分为组Ⅱ-Ⅳ。外科方法建立腹主动脉瘤模型后行介入治疗并行影像学和肉眼检查。结果 影像学检查：组I即对照组瘤腔非;组Ⅱ瘤腔已闭合;组Ⅲ残留一小瘤腔;组Ⅳ显示一大的瘤腔,支架无移位。肉眼检查显示：组I：腹主动脉破裂口存在;组Ⅱ：腹主动脉破裂口已被支架和新生内膜完全覆盖,瘤腔内充满条索状机化物;组Ⅲ：破裂口几乎被支架和新生内膜所覆盖,仅遗留有一直径约1．0cm的小瘤腔,但瘤壁呈向心性增厚;组Ⅳ：破裂口仅部分被支架和新生内膜所覆盖,中央处遗留有直径1．0－1．5cm破裂口未被新生内膜覆盖,仍有一大瘤腔。结论 国产网孔面积为4．3mm^2的镍钛形状记忆合金血管内裸支架,对瘤腔入口≤1cm的腹主动脉瘤有治疗作用;瘤腔入口＞1cm但≤2cm可防止动脉瘤继续扩张和迟发破裂;瘤腔入口≥3cm则无任何治疗作用。     

急性心肌梗死患者腹主动脉瘤覆膜支架植入术的麻醉管理

急性心肌梗死患者围术期心脏并发症风险极高,与此同时,腹主动脉瘤覆膜支架置入术也属于可导致心脏不良事件高发的高危手术.对于1例急性心肌梗死后8d,拟行腹主动脉瘤覆膜置入术的患者,在充分了解手术特点的基础上,根据手术要求滴定麻醉药物,维持血流动力学的稳定,维持心肌氧供需平衡,制定合理的镇痛镇静方案,从而保证患者平稳渡过围手术期,避免了严重并发症的发生.     

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.     

INCRAFT覆膜支架腔内修复腹主动脉瘤的单中心应用经验

目的 探讨INCRAFT覆膜支架腔内治疗腹主动脉瘤的临床效果.方法 回顾性分析上海交通大学医学院附属仁济医院2018年1月至2020年10月应用INCRAFT覆膜支架腔内治疗的51例腹主动脉瘤患者临床资料,患者根据入路直径分为入路狭窄组(30例)和入路正常组(21例),比较两组术后内漏和再干预情况.结果 技术成功率10...     

腹主动脉瘤行支架置入术麻醉一例

近日 ,我院为 1例主动脉瘤患者在全麻下施行了腹主动脉腔内人工血管带膜支架置入术 ,报告如下。临床资料一般资料　患者 ,男 ,5 0岁 ,ＡＳＡⅡ级。 3年前曾因腰部外伤行腰椎管开窗术 ,住院期间出现左髂动脉瘤破裂 ,失血性休克 ,行左髂动脉瘤切除术。入院后各项理化检查基本在正常范围内 ,ＭＲＩ提示腹主动脉中下段距右肾动脉下约4 5ｃｍ处有一动脉瘤 ,大小约 1 2ｃｍ× 1 2ｃｍ。麻醉方法　术前用药为哌替啶 2 5ｍｇ、异丙嗪 12 5ｍｇ、东莨菪碱 0 3ｍｇ。患者入导管室后常规监测ＥＣＧ、ＮＩＢＰ、ＰＥＴＣＯ2 、ＳｐＯ2 。于前臂静脉建…     

人工开窗型覆膜支架治疗复杂腹主动脉瘤的临床研究

覆膜支架腔内修复腹主动脉瘤因其微创,生存率高的优势得到广泛的临床应用,适应证也不断扩展.然而复杂腹主动脉瘤解剖结构的特殊性,使之成为腔内修复的危险因素.目前开窗型覆膜支架更多地应用于复杂腹主动脉瘤,但需按患者的主动脉解剖结构进行定制,使患者治疗时间窗受到限制,我们在2009年10月至2012年6月经人工开窗技术实施腔内修复11例复杂的腹主动脉瘤,报告如下.     

BAI型国产覆膜支架治疗犬主动脉假性动脉瘤

目的　探讨BAI型国产覆膜支架治疗动物主动脉假性动脉瘤的可行性和有效性。方法　在 16条犬中建立腹主动脉假性动脉瘤模型 ,分为 4组 ,各 4只 ,1组为对照组 ,其余 3组为实验组。实验组 2周后行国产镍钛记忆合金覆膜支架 (BAI型 )植入术。分别于术后第 2、3、6个月时处死动物 ,处死前做CT及动脉造影。病理检查包括光镜与电镜。结果　国产覆膜支架 (BAI型 )均成功地将动脉瘤封闭 ,成功率为 10 0 %。术后死亡率为 0。覆膜支架无移位 ,无内漏。 2例出现支架内血栓栓塞 ,栓塞率 17%。其余病理检查示管腔通畅 ,覆膜内表面均已内皮化。 7条犬的腰动脉再通。结论　国产覆膜支架 (BAI型 )在犬的腹主动脉假性动脉瘤模型的治疗中是可行、有效的。     

覆膜支架植入术治疗急性创伤性胸主动脉瘤1例

患者男,40岁,因＂1 h前发生车祸,全身多处受伤,意识不清＂入院。腹部超声见肝、脾破裂。于全麻下行剖腹探查术、肝破裂修补术、胃浆膜修补术、脾破裂修补术、结肠系膜修补术、面部皮肤裂伤清创缝合术,术后转ICU,持续呼吸机辅助呼吸,     

自制国产化支架-移植物腔内治疗腹主动脉瘤的实验研究

目的 探讨自制国产化支架、移植物在治疗犬腹主动脉瘤中的作用。方法 以国产镍钛合金丝纺织成网状管型支架,外套以国产真丝涤纶交织人造血管,装入导鞘制成支架-移植物系统;用胰蛋白酶灌注犬肾下腹主动脉段形成动脉瘤模型;用血管腔内技术将支架-移植物置入腹主动脉内,隔绝血流分别于第1周、1个月、3个月和6个月末观察通畅度及新生内膜生长。结果 20条模型犬接受手术,成功19条,支架置入后能充分展开并恢复形状,1个月末,支架内表面90%被新生内膜覆盖,3个月末几达100%,6个月末,79%的支架保持通畅,无移位、内漏等并发症。结论 自制国产化支架、移植物有良好的生物相容性和较高的通畅率,可用于腹主动脉瘤的治疗。     

经颈动脉腔内技术重建主动脉弓治疗Stanford A型夹层动脉瘤(附1例报告)

目的探讨血管腔内技术重建主动脉弓治疗升主动脉、主动脉弓病变的可行性。方法2005年,对1例StanfordA型夹层动脉瘤,腔内修复主动脉病变之前做右颈总动脉-左颈总动脉-左锁骨下动脉的旁路术;经右颈总动脉将修改的分叉支架型血管主体放入升主动脉,长臂位于无名动脉。短臂应用延长支架型血管延伸至降主动脉。通过腔内技术重建主动脉弓实现累及升主动脉和主动脉弓主动脉病变的微创治疗。结果腔内修复术后移植物形态良好,血流通畅,病变被隔绝,脑、躯干、四肢循环稳定。无严重并发症。结论该手术方案设计合理、技术可行。可能成为复杂胸主动脉病变新的腔内治疗模式。     

Unusual treatment of abdominal aortic aneurysm: Aortic stenting with covered stent

INTRODUCTIONIt is now becoming increasingly difficult to accept that some patients are not suitable for surgery due to high surgical risk. The continuous technological progress, in the endovascular field in particular, are urging surgeons to put the limit even more forth.PRESENTATION OF CASEWe are going to describe an endovascular option used to treat an infrarenal aortic aneurysm where the diameter of the iliac vessels couldn’t allow the use of any device available on the market. Three covered AdvantaV12 stents were placed in series in the aorta to build the endoprosthesis body and two Bard Fluency 8 mm × 60 mm were then placed in a “kissing way” into the common iliac arteries like legs.DISCUSSIONContinuous technological progress, particularly in the endovascular field, is driving surgeons to push the limits even further. Nevertheless, some things still seem not to be possible, but in comparison to traditional surgery where all is well demonstrated and documented, the endovascular approach is still a young discipline and allows us to try to find new solutions.CONCLUSIONWe can therefore assert that in exceptional circumstances, an aortic endoprosthesis can be built inside the aortic lumen using covered stents.     

腹主动脉瘤腔内隔绝术中髂动脉的处理

目的:总结腹主动脉瘤(AAA)行腔内隔绝术时髂动脉的处理方式。方法:2004年7月至2010年11月共对43例瘤体累及单侧或双侧髂动脉分叉的AAA行腔内隔绝术,其中单侧髂动脉分叉受累27例,双侧髂动脉分叉受累16例。根据髂动脉病变情况,分别采取髂内动脉单纯覆盖、髂内动脉栓塞后覆盖、髂动脉外环结扎、一侧髂内动脉重建等不同的处理方法。结果:所有病例均操作成功,手术结束时无Ⅰ型内漏存在。术后出现臀部间歇性跛行6例(14.0%),便血1例(2.3%),无病例发生臀部或会阴部皮肤坏死、肠坏死及死亡。结论:术中避免同时封闭双侧髂内动脉,尽量保留一侧髂内动脉是很重要的。     

Incidence of stent graft failure from type IIIB endoleak in contemporary endovascular abdominal aortic aneurysm repair

BackgroundType IIIB endoleak from material failure can lead to aneurysmal sac enlargement and latent rupture after endovascular repair of abdominal aortic aneurysm. Long-term durability of the endovascular stent graft is largely unknown, and the complication rate from device failure due to material fatigue may be underappreciated. In addition, even with advancement in imaging techniques, recognition of type IIIB endoleak can be challenging, which can lead to delay in intervention.MethodsA review of the literature was performed in PubMed and Google Scholar, yielding 23 articles with 46 case reports of type IIIB endoleak from various Food and Drug Administration-approved stent grafts after endovascular repair of infrarenal abdominal aortic aneurysm.ResultsThe most common location of type IIIB endoleak occurred in the main body (34.8%), followed by the area of the flow divider (32.6%). Sac growth was identified in 63% (29/46) of cases. Diagnosis of the endoleak occurred an average of 54.3 months after the index operation. Endovascular repair was the primary approach for elective repair of type IIIB endoleak (61.3% vs 13.3%). Perioperative mortality was higher in ruptured or symptomatic patients compared with patients undergoing elective repair (33.3% vs 6.5%).ConclusionsThe actual incidence of type IIIB endoleak is still lacking, and the etiology may be multifactorial. Therefore, suspicion of type IIIB endoleak requires appropriate imaging techniques and prompt intervention to reduce the perioperative mortality rate.     

Limb graft occlusion after endovascular aneurysm repair with the Cook Zenith Alpha abdominal graft

ObjectivePrior reports of the low profile Zenith Alpha abdominal graft (Cook Medical Inc, Bloomington, IN) have shown impaired limb graft patency to be the primary causes of reintervention. Special notices from the manufacturer have indicated certain instructions for use (IFU) violations as the main reasons for these complications. In the present study, we assessed the incidence of limb graft occlusion (LGO) and analyzed the effects of the detailed anatomic risk factors for LGO highlighted in the IFU and previously reported studies.MethodsA retrospective study was performed of 241 patients treated with the low profile Zenith Alpha at a single institution from October 1, 2015 to September 30, 2018. All computed tomography angiograms were analyzed using three-dimensional software. Data were extracted from the electronic medical records until the end of the study period (December 31, 2020). The cumulative incidence of LGO and LGO-related reinterventions were assessed. A regression analysis was performed to evaluate the possible risk factors associated with the development of LGO at specified time points. These included aortic and iliac diameters, graft component oversizing, iliac tortuosity and calcification, overlap of graft components, proximal alignment of ipsilateral and contralateral legs, and sealing zone in the external iliac artery. Reader agreement of iliac calcification and tortuosity was assessed in patients with LGO.ResultsA total of 33 limbs (7%) in 27 patients (11%) had become occluded. The cumulative incidence of LGO was 7% (95% confidence interval [CI], 5%-9%) per limb up to 3 years postoperatively. The previously described risk factors for LGO were studied using regression analysis; however, no positive association with LGO was identified. Heavily calcified common iliac arteries (CIAs) and external iliac arteries were protective against LGO compared with noncalcified vessels up to 3 years postoperatively (decreased risk, 17% [95% CI, ?27% to ?7%]; P = .001; and 15% [95% CI, ?26 to ?5]; P = .005, respectively). The reader agreement of iliac calcification and tortuosity showed substantial agreement (CIA intrareader kappa = 0.75; CIA interreader kappa = 0.62) and almost perfect agreement (intrareader kappa = 0.85; interreader kappa = 0.84), respectively.ConclusionsThe cumulative incidence of LGO after endovascular aneurysm repair with the Zenith Alpha graft was 7% per limb up to 3 years postoperatively. None of the analyzed risk factors suggested by the IFUs or current literature were positively associated with LGO.     

Endoluminal stent graft repair for acute and chronic type B aortic dissection and atherosclerotic aneurysm of the thoracic aorta: an interdisciplinary task

Objective: Endoluminal thoracic aortic stenting is a new therapeutic tool in reducing the operative trauma of the patient. However, the inherent risks of aortic stent grafting are perivascular leakage, stent dislocation, blunt rupture of the aorta, side branch occlusion and neurological sequelae. To reduce these risks, in our institution all stent implantations were performed in close collaboration with our fellow cardiologists under biplane X-ray control supported by simultaneous intravascular and transoesophageal ultrasound imaging. Methods: Between August 1999 and August 2001, endovascular stent graft repair was performed in 34 patients (27 male, seven female) with a mean age of 68.6±7 years (range 58–84). Indication for treatment was an acute Type B aortic dissection in six patients (18%), a symptomatic chronic Type B dissection in 12 patients (35%), a true aneurysm of the descending aorta in seven patients (21%) and an atherosclerotic contained rupture of the descending aorta in nine (26%) patients. Out of six acute type B dissections three patients (8.8%) and one patient (2.9%) out of the chronic dissection group were in severe haemorrhagic shock, ventilated and required high-dose adrenergic support. The others (30 patients, 88.3%) remained symptomatic despite maximum medical treatment. In a special case a combined surgical and endoluminal stent graft repair was performed. Individually manufactured Talent, Medtronic AVE (33), and Gore (1) stents were used. Follow-up examination was performed 1 week after implantation and repeated every 3 months (mean follow-up 8 months, range 1–24). Results: In all patients the aneurysm or the entry of the dissection could be excluded. The observed hospital mortality was 2.9% (one patient). No perivascular leakage, no stent dislocation, no neurological deficit or perfusion impairment was observed. All patients except four were extubated immediately after the procedure and discharged from hospital on postoperative day 2–3. The late procedure-related mortality was 5.8% (two patients) resulting in an overall mortality of 8.8% (three patients). Conclusion: Stent graft repair is a safe and feasible treatment option for selected patients, especially in emergency situations, if the aortic lesions can be clearly identified and localized. The use of biplane X-ray control combined with simultaneous intravascular and transoesophageal ultrasound imaging in an interdisciplinary approach enables a more precise targeting of the stent landing zone, resulting in low morbidity and mortality rates.     

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。     

腹主动脉瘤腔内隔绝术中短支对接困难的处理

目的:探讨腔内隔绝术治疗腹主动脉瘤术中短支对接困难的处理方法。方法:对本中心自1997年3月至2004年6月间施行的腹主动脉瘤腔内隔绝术进行回顾性研究。共有51例出现短支对接困难。其中,出现导丝进入主体短支产生困难的50例次,对侧单支导入主体短支产生困难的12例次。术中采用了多角度透视法、对侧导丝导引法、左肱动脉穿刺近端漂流法、导丝上下贯通法、球囊扩张法、超硬导丝回撤法和导丝牵张法。结果:多角度透视法应用于50例病人,对侧导丝导引法14例,左肱动脉穿刺近端漂流法10例,导丝上下贯通法3例,球囊扩张法2例,超硬导丝回撤法10例,导丝牵张法5例。51例病人均获成功对接,使分叉型移植物成功地隔绝了腹主动脉瘤。结论:短支对接是放置分叉型移植物手术操作过程中的难点,短支对接困难会造成手术的时间延长甚至失败。利用多种血管腔内技术可以解决这一问题。     

腹主动脉瘤腔内修复术后髂支闭塞的治疗

目的 总结腹主动脉瘤腔内修复术(abdominal aortic aneurysm endovascular repair,EVAR)后髂支闭塞患者的病因、治疗选择,并评价治疗结果.方法 回顾性分析2008年1月至2012年12月收治的305例患者的临床资料,所有患者使用分叉支架型血管,术后6例男性患者的髂支(1.97％)在EVAR术后0～36个月发生闭塞.其中4例患者出现髂支移植物扭曲,出现扭曲的3个分支中全部发生血栓形成.临床表现为1例患者出现静息痛;4例患者出现跛行;另1例患者无症状.治疗:1例患者采用取栓+股-股旁路;1例采用髂支封堵+股-股旁路;4例患者采用取栓+支架植入.结果 6例患者手术均成功,静息痛和跛行症状消失.6例患者随访时间为6 ～18个月,平均(10±8)个月.5例患者无下肢缺血症状发生,1例患者术后半年跛行症状再次加重,行下肢动脉球囊扩张+支架植入术治疗后症状消失.结论 髂动脉扭曲可能是EVAR术后髂支闭塞的重要因素.外科旁路手术和血管腔内治疗是治疗EVAR术后发生的髂支闭塞有效和安全的方法.