肾下腹主动脉瘤105例腔内修复的早中期疗效

目的 评估肾下腹主动脉瘤腔内修复治疗的早中期疗效.方法 回顾分析2001年1月至2007年2月105例肾下腹主动脉瘤行腔内修复治疗的经过、结果和并发症.结果 所有患者均获技术成功,82例(78.09%)获随访,随访时间1～73个月,平均(8.9 4±5.8)个月.围手术期死亡3例(2.86%),分别死于急性心肌梗死、多系统器官功能衰竭和上消化道大出血.1例(1.21%)术后30个月死于肝癌.原发性内漏21例:Ⅰ型18例,其中10例行球囊扩张(9例)或延伸段植入(1例)后治愈,8例自愈;2例Ⅱ型内漏自愈;1例Ⅲ型内漏支架植入后治愈.1例于术后2周支架的一侧髂支血栓形成,急诊行股-股动脉人工血管旁路术.4例迟发性Ⅰ型内漏.随访观察.1例于术后6年支架向远心端移位,无明显内漏而随访观察.2例支架感染发生于术后1和3个月,行清创引流和抗感染治疗后痊愈.随访期间,9例股-股或髂-股动脉旁路和3例髂内动脉旁路通畅.结论 腔内修复治疗肾下腹主动脉瘤安全、有效,早、中期疗效较好.

Short to midterm results of endovascular repair for 105 cases of infrarenal abdominal aortic aneurysms

Objective To assess short to midterm outcome of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAA) in 105 cases. Methods Stent-grafts were placed into 105 patients with infrarenal AAA between January 2001 and February 2007. The clinical data of those cases were retrospectively analyzed. Results Primary technical success rate was 100%. Eighty-two cases (78.09%) were followed-up for 1 to 73 months (mean, 8.9±5.8 months). Three cases (2.86%) died during peri-operative period, from acute cardiac infarction, multi-organ failure and significant upper gastrointestinal bleeding, respectively. Another one died from hepatic cancer 30 months after EVAR. Twenty-one cases experienced primary endoleak. Eighteen were type Ⅰ, among which 10 underwent secondary intervention in the form of balloon dilatation (n=9) and stent-graft placement (n=1), 8 sealed spontaneously. Two caes were type Ⅱ and sealed spontaneously. One type Ⅲ was treated by placing a stent-graft. An emergent femorofemoral crossover was performed for one graft limb thrombosis 2 weeks after EVAR. Four late type Ⅰ endoleaks occurred. One stent-graft migration without endoleak was cured conservatively. Two atent-graft infections occurred 1 month and 3 months after EVAR respectively, and were cured with debridement, drainage and antibiotics. Nine femorofemoral or iliofemoral bypass and three internal iliac bypasses were all patent during the follow-up period. Conclusion Endovascular repair is a safe and effective method for infrarenal AAA with perfect short to midterm outcomes.