高外科风险腹主动脉瘤腔内修复术的近远期结果

目的 探讨高外科风险腹主动脉瘤患者接受腔内修复术治疗的近远期结果.方法 1997年7月至2011年7月,120例因肾下腹主动脉瘤行腔内修复术治疗的高外科风险患者纳入本研究.本组患者男性96例,女性24例;年龄52～95岁,平均74岁.平均动脉瘤直径(57±8)mm.术后1、3、6、12个月及此后每年进行CT血管造影或B超随访.主要研究内容是手术病死率及远期生存率,次要研究内容是二次手术率、动脉瘤体术后的变化以及支架的通畅率.结果 全身麻醉83例,局部麻醉37例.术后Ⅰ型内漏5例,Ⅱ型内漏25例,Ⅲ型内漏1例,技术成功率95％.手术病死率2.5％.随访6～144个月,平均(36±3)个月.术后1年生存率为92％,3年生存率为75％,5年生存率为43％.术后3年支架的一、二期通畅率分别为97％和100％.5年二次手术率为10％ (12/120),手术原因为:7例内漏,2例支架断裂,2例支架移位,1例支架内血栓形成.结论 高外科风险腹主动脉瘤患者接受腔内修复术治疗的近远期结果满意,证实该技术适用于这类人群.

Endovascular aneurysm repair in high-surgical-risk abdominal aortic aneurysm patients: initial and long-term results

Objective To evaluate the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk abdominal aortic aneurysm (AAA) patients.Methods From July 1997 to July 2011,120 consecutive high-surgical-risk patients with AAA who were treated electively using a bifurcated aortic endograft were entered in a registry.There were 96 male and 24 female patients,aged from 52 to 95 years with a mean of 74 years.Follow-up protocol consisted of computed tomography angiograms or ultrasound performed at 3,6,9,12 months,and annually thereafter.The main goal was evaluation of the operative mortality and the long-term survival of these patients.Secondary goals were determination of the frequency of secondary operations,the outcome of the aneurysm sac,and primary and secondary patency rates after aortic endograft placement.Results Mean aneurysm diameter was ( 57 ± 8 ) mm.Thirty-seven patients were operated under local anesthesia and eighty-three under general anesthesia. Five typeⅠendoleaks,twenty-five type Ⅱ endoleaks and one type Ⅲ endoleak occurred during the perioperative period.The technical success rate was 95％.Operative mortality was 2.5％.The survival rates at 1-,3- and 5-year were 92％,75％ and 43％ respectively.The mean follow up was (36 ±3) months.Primary and secondary patency rates at 3 year were respectively 97％ and 100％.Secondary intervention rate was 10％ (12/120)at 5 year.The reasons included endoleaks for 7 patients,stent-grafts fracture for 2 patients,stent-grafts migration for 2 patients and stent-graft thrombosis for 1 patients.Conclusions Initial and long-term results with endograft repair of AAA in high-surgical-risk patients were satisfactory.These results appear to justify endovascular repair for this patient population.