孤立性腹主动脉夹层的诊断与治疗：附27例报告

目的:总结孤立性腹主动脉夹层(IAAD)的诊治经验。方法:回顾性分析2010年1月—2015年8月期间诊治的IAAD患者的临床资料,主要包括患者一般资料、诊断与治疗方法以及生存情况。结果:共27例IAAD患者入组,其中男17例(63.0%,17/27),女10例(37.0%,10/27);合并高血压9例(33.3%,9/27);外伤性IAAD 1例(3.7%,1/27),自发性IAAD 26例(96.3%,26/27)。所有患者均由CT血管造影(CTA)明确诊断,均经腹主动脉腔内修复术(EVAR)治疗,技术成功率100%。EVAR术中植入分叉型人工血管内支架20例(74.1%,20/27),直型人工血管内支架7例(25.9%,7/27)。随访26例(96.3%,26/27),平均随访(11.8±5.0)个月,患者均正常生存,无异常腹部体征,腹主动脉CTA提示腹主动脉重构良好,未见内漏、新发夹层以及支架移位等并发症。结论:IAAD属临床少见病,发病时可以表现为腰腹痛等非特异性症状或无症状,EVAR治疗IAAD可行且近期疗效佳,但长期疗效仍待进一步随访结果。     

体外开窗主动脉腔内修复术治疗近肾型腹主动脉假性动脉瘤

目的 探讨体外开窗主动脉腔内修复术在近肾型腹主动脉假性动脉瘤中的应用及近中期疗效.方法 回顾性分析2016年10月至2019年7月河南省人民医院血管外科5例近肾腹主动脉假性动脉瘤腔内修复术的临床资料,包括手术方式、手术入路、体外开窗技巧、主体支架半释放装置制作、随访资料等.结果 5例患者均成功实施体外开窗腹主动脉假性动...     

孤立性腹主动脉夹层动脉瘤的诊疗体会

目的探讨孤立性腹主动脉夹层动脉瘤的诊疗体会。方法回顾性分析2002年8月—2009年11月经手术治疗和腔内治疗的4例孤立性腹主动脉夹层动脉瘤的临床资料。患者术前均通过CT血管成像(CTA)或血管造影明确诊断,3例采用传统的腹主动脉夹层动脉瘤切除、人工血管置换术,1例行分叉型带膜支架腔内治疗。结果所有患者夹层均得到完全修复,未出现内脏动脉缺血、肾缺血、下肢缺血等并发症的发生,术后患者随访3个月至3年,效果满意。结论孤立性腹主动脉夹层发病率低,CTA是诊断腹主动脉夹层最常用的方法 ,手术治疗和腔内治疗都能取得良好的治疗效果,相比手术治疗,腔内治疗并发症少,住院时间短,但仅适用于解剖学条件良好的患者。     

浅析Stanford B型主动脉夹层胸主动脉腔内修复术后支架远端并发症

胸主动脉腔内修复术（TEVAR）现已逐渐成熟,成为临床治疗胸主动脉夹层的主要手段。腔内治疗拥有创口小,围术期死亡率低的优点,但长期随访结果相比开放手术缺少明显优势。TEVAR术后胸主动脉段虽得到处理,但腹主动脉及其分支在远期随访中会出现瘤样扩张、新发破口以及分支血管支配的器官缺血、功能不全等并发症。为减少该类并发症出现...     

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。     

INCRAFT腹主动脉覆膜支架系统治疗腹主动脉瘤

目的探讨INCRAFT腹主动脉覆膜支架系统腔内修复治疗腹主动脉瘤的效果。方法回顾性分析2017年2月～2018年4月使用INCRAFT腹主动脉覆膜支架系统治疗腹主动脉瘤20例资料,其中18例存在超适应证的不良瘤颈因素。局麻强化手术15例,气管插管全麻手术5例。均采用预置缝合器的经皮腹主动脉腔内修复手术。结果技术成功率100%。1例术中腹主动脉近端夹层,保守观察;其余19例无围术期不良事件。术后随访6～20(12. 0±4. 6)月,1例术后15个月出现Ⅰb型内漏,再次腔内修复,其余19例无不良事件。生存分析显示免于再干预率为术后12个月100%,术后18个月85. 7%。结论 INCRAFT腹主动脉支架系统可用于不良瘤颈腹主动脉瘤腔内修复手术,近期效果显示良好的有效性和安全性。     

一体式覆膜支架在腹主动脉腔内修复中的应用

目的:总结一体式覆膜支架在腹主动脉以及髂动脉病变中的应用效果。方法:回顾性分析应用一体式腹主动脉覆膜支架腔内修复腹主动脉瘤15例、髂动脉瘤5例及腹主动脉或髂动脉夹层5例的临床资料。结果:平均时间42.4 min,手术成功率100%(25/25)。术后无I、III型内漏,发生髂动脉血栓形成1例,围术期无死亡病例。随访3~16个月复查无动脉瘤复发和II型内漏。结论:一体式覆膜支架是腹主动脉瘤和夹层动脉瘤腔内治疗方法的一种较好选择,具有快速、简单、有效的优点;其远期疗效需进一步观察。     

腹主动脉夹层的诊断和治疗现状

腹主动脉夹层(AAD)是一种罕见的严重主动脉疾病,好发于男性,与吸烟、高血压、高脂血症关系密切。患者临床表现呈多样性,或无明显症状,容易导致误诊、漏诊,延误治疗。增强CT是诊断AAD的首选。初始治疗多采取保守治疗,通过药物治疗严格控制血压和心率,并结合影像学随访。当疾病进展出现手术指征时,应积极采取手术治疗。主动脉覆膜支架腔内修复术是AAD的首选的手术方式,开放手术多用于病变解剖学条件不适合腔内修复术的患者。腔内修复术难度较高,详细的术前评估,制定合理的手术方案是腔内修复术成功的关键。     

真腔覆膜支架点状植入联合假腔内栓塞技术治疗腔内修复术后主动脉夹层动脉瘤

目的 ：回顾性评价真腔覆膜支架点状植入联合假腔内栓塞技术（spot stenting combined with false lumen endovascular occlusive repair,SS-FLEVOR）治疗腔内修复术后主动脉夹层动脉瘤的中期结果 。方法 ：收集2016年10月至2020年10月间采用SS-FLEVOR治疗胸主动脉腔内修复（thoracic endovascular aortic repair, TEVAR）术后主动脉夹层动脉瘤病人围术期及随访资料。分析病人手术前后胸主动脉、腹主动脉真腔最大径、假腔血栓化及内脏动脉分支支架通畅情况。结果：TEVAR术后远端瘤样扩张病人17例,平均年龄（54.5±14.5）岁,女3例。SS-FLEVOR手术均成功,平均手术时间（151.4±37.9） min。平均随访（24.9±20.7）个月。随访期间内脏动脉分支支架均通畅。胸主动脉和腹主动脉假腔均血栓化10例,胸主动脉假腔血栓化3例,胸主动脉和腹主动脉假腔仍存在部分血流4例。因假腔内血流逐渐减少且瘤体未增大,未予以二次干预。胸主动脉和腹主动脉真腔最大径均较术前增大。术前胸...     

胸腹主动脉瘤的外科治疗进展

胸腹主动脉瘤(TAAA)是一种累及降主动脉及腹主动脉的动脉瘤样变,自然病程病死率高,手术治疗难度大。传统的治疗方式为开放手术,随着腔内技术的发展,杂交手术和以开窗支架和分支支架为代表的腔内手术技术在TAAA治疗方面展现出了价值,新近出现的八爪鱼技术进一步完善了腔内治疗的术式选择,TAAA的微创治疗正逐步成为可能。     

Die isolierte abdominelle Aortendissektion (IAAD) �C eine seltene Entit?t mit Besonderheiten

Isolated acute abdominal aortic dissection (IAAD) is a rare and potentially life-threatening condition that only accounts for 1.3% of all aortic dissections. Hypertension and a pre-existing abdominal aortic aneurysm are frequently associated with IAAD and males are predominantly affected. The clinical symptoms at presentation vary and contrast-enhanced computed tomography of the aorta should be carried out to confirm the diagnosis. Complications due to impaired perfusion seem to occur more frequently in patients with IAAD compared to patients with type B dissections and require immediate invasive treatment. Treatment options are endovascular, open surgery or a combined approach depending on the underlying pathology and the general condition of the patient. Conservative medicinal treatment of IAAD is administered in approximately 30% of cases but seems to be associated with a poor outcome. Due to the rare occurrence of IAAD there are no long-term follow-up data currently available.     

复杂腹主动脉瘤对近端锚定区的要求及不同技术的评价

近年来,随着腔内技术和器材的迅猛发展,腔内修复术已逐渐取代传统开放手术,成为治疗腹主动脉瘤的首选方法。但是,不良近端锚定区仍然制约着腹主动脉瘤腔内修复术的发展。笔者结合"烟囱技术"、"开窗技术"以及"多分支支架技术",对复杂腹主动脉瘤对近端锚定区的要求及相关临床证据进行简要讨论,为复杂腹主动脉瘤的处理提供些许参考。     

复杂腹主动脉瘤内脏分支重建技术评价

随着腔内治疗技术和器材的发展,腹主动脉瘤腔内修复术已成为腹主动脉瘤的首选治疗方式。而近端锚定区不良以及累及内脏分支的复杂腹主动脉瘤则是制约该技术发展和影响其治疗效果的关键因素。平行支架、开窗支架、分支支架、多层密网支架和去分支等技术是目前重建内脏分支的主要方法,笔者结合相关研究结果对上述技术进行简要讨论,以期为复杂腹主动脉瘤的腔内治疗提供参考。     

Endovascular treatment of two aortoduodenal fistulae

We report the endovascular treatment of two patients presenting with aortoduodenal fistulae. The first patient was a 66-year-old man admitted with hematemesis. He was on clopidogrel and had received a cryopreserved aortic graft for a mycotic abdominal aortic aneurysm five years earlier. Computed tomography (CT) showed aortic pseudoaneurysms in close contact with the duodenum. Endovascular repair was carried out. Twenty-seven months after the procedure the patient remains asymptomatic. The second patient was a 78-year-old man admitted with abdominal pain and nausea. CT revealed an abdominal aortic pseudoaneurysm and aortoduodenal fistula. He suffered from severe chronic obstructive pulmonary disease that greatly increased his surgical morbidity and mortality. An endovascular repair was performed under epidural anesthesia. The patient died of a postoperative pneumonia 38 days after surgery. These two cases illustrate the importance of endovascular aortic repair especially when an open surgical procedure is either difficult or impossible.     

Endovaskuläre Therapie des infrarenalen Bauchaortenaneurysmas mit aortokavaler Fistel

An aortocaval fistula is a rare complication of a symptomatic or ruptured infrarenal aortic aneurysm having a frequency of 3–6%. Patients typically present with clinical signs of diffuse abdominal pain associated with increasing venous congestion and tachycardia, rapid cardiopulmonary decompensation with acute dyspnea and an audible machinery-like bruit. Frequently, the diagnosis is obtained only during open aneurysm repair. Perioperative mortality is high, ranging from 20% to 60%. We report our experience with endovascular aortic repair in patients with symptomatic infrarenal aortic aneurysms and aortocaval fistula, and review the literature. Endovascular stent graft implantation seems to be a promising new treatment option for patients with abdominal aortic aneurysms, rupture into the inferior vena cava, and aortoiliac configurations acceptable for endovascular therapy.     

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。     

Extended use of endovascular aneurysm sealing: Chimneys for juxtarenal aneurysms

Hostile infrarenal aortic neck anatomy presents a challenge for the endovascular treatment of abdominal aortic aneurysm. Open surgical repair has been seen as the gold standard treatment for juxtarenal abdominal aortic aneurysm; however, endovascular techniques are now becoming more prevalent, particularly in patients deemed high risk for morbidity and mortality with open repair. The morphology of an aneurysm is a determinant of long-term outcomes, and short aneurysm necks are associated with poorer outcomes and a higher rate of secondary reinterventions. Parallel grafts have been used in combination with endovascular aneurysm repair to elongate the sealing zone into the paravisceral segment of the aorta. This technique is associated with a risk of proximal Type I endoleak due to “guttering.” This risk may be decreased when parallel grafts are used in combination with endovascular aneurysm sealing and, as such, this technique may represent an alternative to current techniques for the treatment of juxtarenal abdominal aortic aneurysm, such as the use of conventional bifurcated grafts (with or without parallel grafts) and fenestrated endovascular stent grafts.     

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.     

开窗技术治疗近肾腹主动脉瘤的现状与评价

开窗主动脉腔内修复技术（F-EVAR）是腔内修复技术的又一次革命,实现了经腔内重建主动脉分支血管,使原来无法应用常规技术处理的短瘤颈及近肾腹主动脉瘤（J-AAA）能够接受微创腔内治疗。笔者就该技术的技术背景、现状、技术要点及局限性进行阐述,认为F-EVAR无论从理念还是从技术上堪称当代腔内主动脉外科发展的经典,但应用时,要重视其局限性,合理选择适应证。