腹主动脉假性动脉瘤的腔内修复治疗

目的：总结覆膜支架置入腔内修复术治疗腹主动脉假性动脉瘤的经验，探讨其腔内治疗的安全性及有效性。方法：2011年1月至2012年12月间，收治的9例腹主动脉假性动脉瘤患者，男性7例，女性2例，年龄43～78岁，平均（66．7±11．0）岁。术前均行影像学仔细评估，采用切开或直接穿刺的方式置人覆膜支架隔绝瘤体。9例共置入20枚覆膜支架（其中1例采用“开窗”支架，5例采用一体式分叉型支架，3例采用直筒型支架）。术后1，3，6及12个月均行CTA复查，观察有无内漏，瘤腔是否完全血栓化。结果：9例均成功地置入覆膜支架，技术成功率100％（9／9）。围手术期无死亡病例。随访1—23个月，1例术后1．5个月因感染复发转外科手术治疗，1例术后5个月死于呼吸衰竭，余患者瘤腔均完全血栓化。随访期间病死率11．1％（1／9），并发症发生率22．2％（2／9）。结论：采用覆膜支架植入腔内修复术治疗腹主动脉假性动脉瘤近期疗效安全可靠，中远期疗效尚需进一步观察。

Endovascular therapy for abdominal aortic pseudoaneurysms

Objective：To summarize our experience on the endovascular treatment of pseudoaneurysm of abdominal aorta. Methods ： From January 2011 to November 2012, 9 patients [ 7 men; mean age （ 66. 7 ± 11.0） years, range 43 - 78 ] came to our department because of abdominal aortic pseudoaneurysm. Carefully a- nalysis of the images before the operation was necessary, and the stent-graft was implanted totally percutenously or by femoral incision. 20 stem-grafts were implanted successfully in 9 abdominal aortas （ 1 with fenestration stent-graft, 5 with unibody bifurcated stent-graft, 3 with tube stent-graft）. Follow-up CTA was performed at ap- proximately 1,3,6 and 12 months to observe whether there is endoleak or complete thrombosis. Results：Stent- grafts were implanted successfully for all patients. The technical success rate was 100. 00% （ n = 9 ）. Periopera- tive mortality was zero. Follow-up ranged from 1 month to 23 months. One patient was converted to surgery be- cause of recurrent infection of abdominal aorta and another died of respiratory failure 5 months postoperative during follow-up. Complete thrombosis of the aneurysm occurred in all the other patients. Mortality and morbidi- ty during follow-up was 11.1% （1/9）and 22. 2% （2/9）. Conclusion： It is safe and effective to perform endo- vascular repair for pseudoaneurysms of the abdominal aorta, which presents with good short-term result.