内漏对腹主动脉瘤腔内隔绝术后瘤腔内压力的影响

目的 探讨内漏状态下腹主动脉瘤(AAA)腔内隔绝术(EVE)后瘤腔内压力的变化。方法 通过建立犬AAA EVE后内漏模型，测定内漏存在前后瘤腔内压力的变化。结果 内漏状态下瘤腔内平均动脉压明显升高，而内漏封闭后压力显著下降，且曲线平直。结论 瘤腔内压力曲线可作为评估EVE后瘤壁所受负荷的变化，也可作为判断内漏存在的方法之一。     

不使用造影剂的腹主动脉瘤腔内隔绝术

目的：探讨一种不使用造影剂的腹主动脉瘤（AAA）腔内隔绝术（EVE），治疗合并肾功能不全的AAA患者。方法：对3例合并肾功能不全的AAA患者在不使用造影剂条件下实施AAA EVE，并对术前评估内容进行分析。结果：3例患者手术均获成功，2例采用分叉型移植物，1例采用直型移植物。术后随访结果表明，动脉瘤被完全隔绝，无内漏，瘤腔内血栓形成；移植物内血流通畅，周围无异常血充。结论：选择近端瘤颈较长的患者，术前对肾动脉及髂内动脉开口位置等指标进行准确评估，不使用造影剂同样可以完成AAA EVE。     

腔内隔绝术治疗瘤颈扭曲大于60°的腹主动脉瘤

目的　探讨腔内隔绝术 (EVE)治疗瘤颈扭曲大于 6 0°腹主动脉瘤 (AAA)的安全性和可行性。从而扩大治疗AAA的适用范围。方法　对瘤颈扭曲大于 6 0°的AAA通过技术改进 (术中对瘤颈进行捆扎或置入Cuff) ,然后实施EVE。结果　对瘤颈扭曲大于 6 0°的AAA成功地实施了EVE ,术后复查彩超、CTA、MRA证实 :瘤体被完全隔绝 ,支架无移位、扭曲及内漏现象。结论　EVE是一种治疗瘤颈扭曲大于 6 0°的AAA简便可行的方法 ,其主要特点是安全、微创、简捷 ,特别适于合并多种并存病的年老体弱患者。     

腹主动脉瘤腔内隔绝术后迟发型远端内漏Ⅱ期腔内治疗

目的：探讨腹主动脉瘤（AAA）腔内隔绝术EVE后迟发型远端内漏的Ⅱ期腔内治疗方法的价值。方法：为3例AAA EVE3年以后迟发型远端内漏患者进行了Ⅱ期延伸移植物置入治疗，2例经双侧动脉切开、两侧各置入1枚延伸移植物，1例经腹膜后径路和股动脉径路完成3枚延伸移植物置入。结果：3例均应用了贯穿导丝牵张技术，延伸移植物置入完成后均将内漏消除。结论：Vanguard支架-人造血管系统的结构特点可能是导致远期远端内漏的原因；延伸移植物是治疗的有效方法。导丝牵张技术有助于手术成功并节约手术时间。     

腹主动脉瘤腔内隔绝术围手术期护理1例

腹主动脉瘤（abdominal aortic aneurysms，AAA）严重危及生命的是瘤体破裂，一旦破裂死亡率高达78％-94％。动脉瘤腔内隔绝术（endovascular exclusion，EVE）具有创伤小、并发症少、恢复快、死亡率低等优点。我院2004—10开展EVE治疗1例，现报告如下。     

腹主动脉瘤腔内隔绝术中内漏动物模型的建立

目的：建立近似人体的腹主动脉瘤（AAA）腔内隔绝术（EVE）后内漏的实验动物模型。方法：采用6只犬 ，以牛颈静脉间置法或前壁补片的方法形成保留腰动脉的肾下型AAA，经髂动脉行AAA EVE，术中采用修剪人造血管和改变支架附着点的方法形成内漏。结果：血管造影示6只犬动脉瘤形态良好，5只犬形成了即时性内漏，内漏来自近端返流，也有近端返流。结论：通过移植物释放位置的变化可以模拟出与人体EVE后相似的即时性内漏，以供血流动力学和治疗研究。     

瘤体动脉分支与腹主动脉瘤腔内隔绝术后Ⅱ型内漏的关系

目的 明确瘤体动脉分支和腹主动脉瘤(AAA)腔内隔绝术(EVE)后Ⅱ型内漏之间的关系。方法 回顾性分析8例行EVE出现Ⅱ型内漏的AAA患者的临床资料。结果 所有患者瘤体上均有数目不等的通畅的动脉分支，术中并发即时性内漏。结论 瘤体上通畅的动脉分支是Ⅱ型内漏发生的主要原因，术后根据瘤径的变化采用相应的动脉栓塞治疗以防止动脉瘤继发性破裂。     

肾下型腹主动脉瘤腔内隔绝术与传统手术对肾功能影响的比较研究

目的：对比肾下型腹主动脉瘤（AAA）腔内隔绝术（EVE）与传统手术（CS）对肾功能的影响。方法：回顾1997年3月至2002年3月间实施的157例肾下型AAA手术，其中EVE组115例，CS组42例，分析比较两组手术前后血肌酐、血尿素氮的变化情况。结果：CS组术后血肌酐、血尿素氮较术前明显升高，并发生急性肾衰1例，而EVE组手术前后两指标无显著差异。结论：EVE对肾下型AAA患者肾功能的影响明显小于CS。     

介入治疗腹主动脉瘤腔内隔绝术的护理体会

腹主动脉瘤(AAA)是最常见的动脉扩张性疾病，传统的方法是手术治疗，但危险性很大，其致命的并发症是动脉瘤破裂致大出血死亡。近年来开展的腔内隔绝术(EVGE)治疗腹主动脉瘤具有安全、微创的特点，2002年12月我院应用分叉型人造血管一内支架复合体腔内隔绝治疗腹主动脉瘤2例，取得满意效果，现将护理体会报告如下。     

腹主动脉瘤腔内隔绝术后神经缺血性损伤

目的：探讨在腹主动脉瘤（AAA）腔内隔绝术（EVE）中神经缺血性损伤的发生原因及防治。临床资料：我科在施行AAA EVE中遇到1例术后发生神经缺血性损伤。患者为Ⅱa型AAA，选用Talent分叉型移植物行EVE，手术顺利。术后出现双侧股部酸痛不适、乏力，伴右侧屈髋无力。行肌电图检查提示双侧腓总神经、胫神经、H反射传导速度均减慢，双侧股神经未能引出动作电位。给予甲钴胺0.5mg肌内注射，隔日1次，地巴唑10mg3次/d，并辅以高压氧治疗和股四头肌功能锻炼。治疗2个月后患者股部疼痛、乏力逐步缓解，无明显功能障碍。复查下肢肌电图无明显改善。结论：AAA EVE后可能会发生脊髓的缺血性损伤，但发生率很低，术中封闭腰动脉是导致脊髓缺血的原因。脊髓缺血性损伤早期治疗最为重要，后期的神经营养治疗和功能锻炼也可以改善部分症状。     

腹主动脉瘤腔内隔绝术后缺血性结肠炎的诊治

为探讨腹主动脉瘤术后并发缺血性结肠炎的诊断和治疗,作者回顾性分析了1997年3月－2000年1月间施行的腹主动脉瘤腔内隔绝术40例,其中30例保留双侧髂内动脉（双侧组）,10例保留单侧髂内动脉或移植物远端固定于双侧髂外动脉、手术重建单侧髂内动脉（单侧组）。统计两组患者的术后肠蠕动恢复时间及肠道并发症。两组患者中仅双侧组1例于术后第28天始出现持续性中下腹隐痛,经纤维结肠镜检查确诊为缺血性结肠炎,经CTA发现术后继发双侧髂内动脉闭塞,经扩血管、促进侧支循环建立等保守治疗缓解;其余患者除并发其他并发症的3例外,均于术后第二天恢复其普食及排气排便。提示腔内隔绝术中保留单侧髂内动脉可避免术后缺血性结肠炎的发生;继发于术后双侧髂内动脉阻塞的慢性缺血性结肠炎,在肠镜随访观察下进行有效的保守治疗是首选治疗方法。     

腹主动脉瘤腔内隔绝术术中及术后移植物相关流出道狭窄的认识和处理

目的：探讨腹主动脉瘤（AAA）腔内隔绝术（EVE）术中及术后移植物相关流出道狭窄的认识和处理。方法：回顾性分析我科1997年3月至2002年10月间施行AAA EVE术中8例出现流出道狭窄，术后出现流出道狭窄3例，均为放置分叉型移植物。狭窄多发生于分叉起始端（5例）。7例给予球囊扩张，2例置入金属支架，2例股股交叉转流术。结果：术后随访1个月-2个年，无下肢缺血表现。结论：对于AAA EVE术中及术后移植物相关流出道狭窄，要及时诊断，判明原因，根据原因采取不同的治疗方法。     

The role of gadolinium-enhanced MR imaging in the preoperative evaluation of inflammatory abdominal aortic aneurysm

Inflammatory abdominal aortic aneurysm is an uncommon variant of abdominal aortic aneurysms. Thorough preoperative imaging of the extent of the aneurysm and inflammation and the associated complications are crucial in the management of this condition. We report a case of inflammatory abdominal aortic aneurysm where, after the initial contrast-enhanced CT, gadolinium-enhanced MR imaging was used to define the true extent of the inflammation and differentiate inflammation from mural thrombus at the iliac extension of the aneurysm. The imaging appearances are presented and the impact of MR imaging on further surgical management options including endovascular repair are discussed.     

内支架置入术治疗胸腹主动脉瘤的临床评价

目的：探讨胸腹主动脉瘤的ESG治疗临床疗效。方法：对10例患者分别行CTA、MRA、DSA检查和ESG治疗，其中Stanford B型夹层动脉瘤6例，真性腹主动脉瘤2例，肾动脉开口以下腹主动脉瘤2例（行分体式支架），所有病例均采用带膜支架。结果：8例行一体式支架腔内隔绝术，2例行分体式支架腔内隔绝术，均获成功。顺利植入，术后造影提示动脉瘤消失．无内漏发生。患者症状完全消失，全部患者在随访期间均未出现术前症状，未见相关并发症。结论：应用ESG治疗胸腹主动脉瘤安全、有效、创伤小、术后恢复快，长期疗效尚待进一步观察。     

Endovascular Repair of Complex Aortic Aneurysms: Intravascular Ultrasound Guidance with an Intracardiac Probe

To assess the accuracy and efficacy of intravascular ultrasound guidance obtained by an intracardiac ultrasound probe during complex aortic endografting. Between November 1999 and July 2002, 19 patients (5 female, 14 male; mean age 73.5 ± 2.1 years) underwent endovascular repair of thoracic (n = 10), complex abdominal (n = 6) and concomitant thoraco-abdominal (n = 3) aortic aneurysm. The most suitable size and configuration of the stent-graft were chosen on the basis of preoperative computed tomographic angiography (CTA) or magnetic resonance angiography (MRA). Intraoperative intravascular ultrasound imaging was obtained using a 9 Fr, 9 MHz intracardiac echocardiography (ICE) probe, 110 cm in length, inserted through a 10 Fr precurved long sheath. The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, the ICE probe allowed us to view the posterior aortic arch and descending thoraco-abdominal aorta without position-related artifacts, and to identify both sites of stent-graft positioning. After stent-graft deployment, the ICE probe allowed us to detect the need for additional modular components to internally reline the aorta in 11 patients, and to discover 2 incomplete graft expansions subsequently treated with adjunctive balloon angioplasty. In 1 patient, the ICE probe supported the decision that the patient was ineligible for the endovascular exclusion procedure. The ICE probe provides accurate information on the anatomy of the posterior aortic arch and thoracic and abdominal aortic aneurysms and a rapid identification of attachment sites and stent-graft pathology, allowing refinement and improvement of the endovascular strategy.     

腹主动脉复合动脉瘤的腔内隔绝术治疗

目的：讨论复合腹主动脉病变进行腔内隔绝术（EVE）的可行性。方法：1例腹主动脉并存真性、假性和夹层动脉瘤患者，经双侧股动脉切开、肱动脉切开引入贯穿导丝，利用导丝导向技术和牵张技术成功置入模块式支架-人造血管移植物，以隔绝瘤体。结果：腔内隔绝操作技术完全成功，3个瘤体同时被隔绝，未加用任何延伸移植，未出现内漏、移位等并发症，重建血流通畅。结论：本例为EVE扩大适应证提供了经验。     

Endovascular abdominal aortic aneurysm repair: how many patients are eligible for endovascular repair?

PURPOSE: The purpose of this study was to determine how many patients with abdominal aortic aneurysm (AAA) are eligible for endovascular abdominal aortic aneurysm repair (EVAR). MATERIALS AND METHODS: We retrospectively reviewed computed tomography (CT) angiograms obtained between January 2002 and June 2003 in 182 patients with suspected AAA. Indication for surgical or endovascular treatment was based on clinical and radiological criteria. The percentage of patients eligible for EVAR was evaluated. RESULTS: Out of a total of 182 patients with suspected AAA studied by CT angiography, after combined radiological-surgical assessment, 130 were considered eligible for surgical or endovascular treatment (71.4%). EVAR was indicated in 51 patients (39.3%, group A) and surgical repair was indicated in 79 patients (60.7%, group B). The reasons for ineligibility for EVAR were the following: unfavourable anatomy of the proximal neck in 41 patients (51.9%), diameter of the aneurysm sac >7 cm in 13 patients (16.4%), markedly tortuous/dilated iliac axis in six patients (7.6%), age <65 years in 17 patients (21.5%) and patient refusal in two cases (2.5%). There were no statistically significant differences in aneurysm diameter (52.7+/-0.8 versus 49.8+/-1.2 mm, p=ns), patients' age (73.2+/-1.2 versus 70.6+/-2.02 years, p=ns) or proximal neck length (2.95+/-1 versus 3.03+/-1.2 cm, p=ns) between groups A and B. CONCLUSIONS: Endovascular repair of abdominal aortic aneurysms through the placement of aortic stent-grafts has now become a viable alternative to open surgery. In recent years, the number of patients treated with EVAR has steadily risen as a result of increased physician experience, availability of new and more versatile devices and improvements in noninvasive imaging techniques. Unfavourable neck anatomy is the primary factor for exclusion from endovascular repair.     

Abdominal aortic aneurysm demonstrated on renal scintigraphy

A 74-year-old hypertensive woman presented with abdominal discomfort and a pulsatile abdominal mass. Anterior abdominal angiography during cardiac blood pool, and renal scintigraphic imaging demonstrated a large abdominal aortic aneurysm. 1, 2 Before endovascular repair with an aortoiliac endograft, the abdominal aneurysm measured 7.5 x 7.0 cm on abdominal computed tomography. This study demonstrates that a suspected abdominal aortic aneurysm can be confirmed using the addition of anterior abdominal imaging with normal posterior imaging at the time of renal scintigraphy.