Percutaneous Endovascular Abdominal Aortic Aneurysm Repair

In this prospective, nonrandomized study, we compared outcome with percutaneous femoral artery closure to that with open femoral arteriotomy in 95 patients who underwent endovascular AAA repair. Devices were introduced using 22 Fr and/or 16 Fr sheaths. The 8 Fr/10 Fr Perclose devices (Perclose Inc., Redwood City, CA) were used in an off-label "preclose technique." Thirty-three patients had bilateral open femoral arteriotomies, 44 patients had bilateral attempted percutaneous closure, and 18 patients had open femoral arteriotomy on one side and attempted percutaneous closure on the other side. Percutaneous closure was successful in 85% (47/55) of 16 Fr sheaths and 64% (29/45) of 22 Fr sheaths (p <0.027). BILATERAL PERCUTANEOUS CLOSURE WAS SUCCESSFUL IN 63% (28/44) OF PATIENTS. CONVERSION TO OPEN FEMORAL ARTERIOTOMY DUE TO BLEEDING OCCURRED IN 24 OF 106 PERCUTANEOUS ATTEMPTS. THERE WERE NO DISSECTIONS, ARTERIAL THROMBOSES, OR PSEUDOANEURYSMS ASSOCIATED WITH PERCUTANEOUS ARTERIAL CLOSURE. WOUND COMPLICATIONS WERE SEEN IN 3.6% (3/84) OF OPEN ARTERIOTOMIES AND 0.9% (1/106) OF ALL PERCUTANEOUS ATTEMPTS AND ARTERIAL CLOSURES (P > 0.05). Gender, previous femoral access, obesity, and iliac occlusive disease were not predictive of percutaneous failure. Procedural success for percutaneous AAA repair is affected by sheath size. Devices delivered through 16 Fr or smaller sheaths will have successful femoral artery closure rates of at least 85%.     

Thoracoabdominal Aneurysm Repair after Failed Endovascular Abdominal Aneurysm Repair Without Endograft Removal

Abstract Open surgical repair after failed endovascular aneurysm repair usually involves complete aneurysm removal and replacement with a prosthetic surgical graft. We describe an alternative strategy of open surgical repair of a thoracoabdominal aneurysm repair after failed endovascular aneurysm repair that entails preserving the functioning portion of the endograft and sewing the thoracoabdominal graft on the existing abdominal endograft . (J Card Surg 2010;25:554‐556)     

腔内修复术治疗破裂型腹主动脉瘤的效果评价

目的分析破裂型腹主动脉瘤(ruptured abdominal aneurysm,r AAA)行腔内修复术(endovascular aortic aneurysm repair,EVAR)与开放手术早期结果,评价EVAR治疗的效果。方法回顾性收集我院2004年1月~2014年1月收治的48例r AAA患者临床资料,根据其手术与否、手术方式的不同分为术前死亡组(n=20)、EVAR组(n=14)和开放手术组(n=14),三组性别、年龄等一般资料比较无统计学差异(P0.05),EVAR组和开放手术组在瘤体直径、收缩压、舒张压方面比较差异均无统计学意义(P0.05)。结果 EVAR组入院至检查时间为(1.2±0.8)h,与开放手术组(7.5±7.1)h比较差异有统计学意义(P=0.006);EVAR组检查至手术时间为(1.8±1.3)h,与开放手术组(16.8±17.7)h比较差异有统计学意义(P=0.007)。死亡组入院至死亡时间与EVAR组比较差异有统计学意义(P0.009)。EVAR组手术时间为(2.3±0.7)h,与开放手术组(5.6±2.0)h比较差异有统计学意义(P0.001);EVAR组的术中出血量为(142.9±279.3)ml,与开放手术组的(3 528.6±3 252.3)ml间差异有统计学意义(P0.001);EVAR组的输血量为(985.7±2 148.7)ml,与开放手术组的(3 100.0±2 285.1)ml间差异有统计学意义(P=0.018);EVAR组的住院时间为(7.1±2.7)d,与开放手术组的(13.7±4.9)d间差异有统计学意义(P0.001);EVAR组的总费用为(20.9±5.8)万元,与开放手术组的(10.1±11.5)万元间差异有统计学意义(P=0.005)。两组并发症率比较,差异无统计学意义(P=0.430)。结论缩短院内抢救准备时间,是r AAA成功救治的要点。EVAR应作为r AAA的一线治疗方案。     

Endovascular Abdominal Aortic Aneurysm Repair in the Octogenarian

The aim of this study was to analyze patient outcomes following endovascular repair of infrarenal abdominal aortic aneurysms (EAR) among patients 80 years of age or older. In this study, reporting standards of the Ad Hoc Committee for Standardized Reporting Practices for Endovascular Aortic Aneurysm Repair of the Society of Vascular Surgery/American Association for Vascular Surgery (SVS/AAVS) were followed. Between August 8, 1996 and February 12, 2001 EAR was performed in 31 patients (29 male and 2 female) with an average age of 83 ± 3 years and an average maximum aneurysm diameter of 59 ± 7 mm. Overall technical success was 90% (28/31) with a single acute conversion and a 6% (2/32) incidence of major morbidity. There were no in-hospital deaths, but two patients (6%) died within 30 days of intervention. Four endoleaks, two type I and two type II, were observed within the first 30 days after endograft implantation and three new type II endoleaks were noted after implant periods that exceeded 1 month. Average follow-up was 16 months, with a single aneurysm-related death that occurred after late conversion to open repair, 2 years following initial endovascular treatment. Kaplan-Meier analysis revealed 3-, 12-, and 24-month estimated survivals of 93% (±5), 75% (±8), and 68% (±10), respectively. Clinical success rates were 90% (±5), 90% (±5), and 72% (±17) at 12, 24, and 36 months, respectively. We conclude that, in the octogenarian with mild to moderate medical comorbidities, endovascular aneurysm repair provides an alternative to open AAA repair with low operative morbidity and good clinical success rates. Elevated SVS/AAVS medical comorbidity scores were not associated with increased operative mortality rates, but they did show a trend toward decreased mid-term survival. Careful consideration of life expectancy and the probability of rupture, as with traditional AAA repair, should dictate necessity for intervention.     

腹主动脉瘤腔内修复术后的并发症

腹主动脉瘤腔内修复术最早于1991年被报道,目前已经发展成为一项成熟可行的技术,但在术后并发症发病率及手术死亡率方面仍存在着相当高的风险。如果腹主动脉瘤腔内修复术欲在未来完全取代传统手术,降低围手术期死亡率并提高长期疗效势在必行。以下将围绕腹主动脉瘤腔内修复术并发症的产生机制、发病率及其带来的问题进行讨论。     

腹主动脉瘤腔内修复术后内漏诊治的研究进展

目的探讨腹主动脉瘤腔内修复术后内漏诊治的研究进展。方法在复习腹主动脉瘤腔内修复术后内漏的发生原因、诊断、治疗研究的文献的基础上,对目前内漏诊断和处理原则进行回顾性分析及总结。结果内漏是腔内修复术后最常见和独特的并发症,其持久性存留意味着腔内治疗的失败。准确的检测、分类和治疗是必要的,其治疗方法是根据其不同来源决定的。对于Ⅰ、Ⅲ型内漏应尽早处理,Ⅱ、Ⅴ型内漏可以观察。内漏可以通过置入袖套状移植物或裸支架、球囊扩张、直接瘤囊穿刺栓塞等技术相互结合来治疗。结论腔内修复术后内漏为主的并发症还是有待解决的临床难题,内漏特性仍然没有完全揭示,诊断与治疗也存在争论,有待进一步研究。     

Impending Aneurysm Rupture after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

Abstract   An 81-year-old male presented with lower abdominal pain radiating to back associated with diaphoresis. He received endovascular repair of an infrarenal abdominal aortic aneurysm 21 months ago. Triple phase abdominal CT showed impending aneurysm rupture secondary to endoleak. After re-stenting and percutaneous transluminal angioplasty, he had an uneventful recovery later.