腔内修复术治疗肾下型腹主动脉瘤的内漏防治：附43例报告

目的：总结应用腔内修复术治疗腹主动脉瘤的经验，探讨内漏的防治策略。方法：回顾性分析齐鲁医院及莱钢医院2007年1月—2012年12月接受腔内治疗的43例肾下型腹主动脉瘤患者临床资料，分析内漏的发生原因、预防和处理。结果：术后发生原发性内漏11例，其中I型8例，III型2例；植入分叉型支架发生9例，植入直管型支架发生2例。1例II型因漏血量小未处理；经一期经过球囊扩张、植入支架型血管或裸支架等处理后，除2例I型内漏仍有残留，其余I，III型内漏均消失。39例患者获随访4~50个月，发现迟发性Ib型、II型内漏各2例，继续随访1~2年，未见瘤体明显增大。3例残留原发性内漏自愈，术后半年复发Ia型内漏1例，导致动脉瘤复发破裂而再次接受腔内治疗。结论：内漏的发生与动脉瘤的解剖学条件、移植物缺陷和操作技术有关；防治内漏需要把握好手术适应证、合理选择支架，并有成熟的操作经验。

Prevention and treatment of endoleak after endovascular repair for infrarenal abdominal aortic aneurysm: a report of 43 cases

Objective: To investigate the prevention and treatment of endoleak by summarizing our experience of endovascular aneurysm repair. Methods: The clinical data of 43 patients with infrarenal abdominal aortic aneurysm undergoing endovascular repair (EVAR) from January 2007 to December 2012 in Qilu Hospital and Laiwu-Steel Company Hospital were analyzed retrospectively. The causes, prevention and treatment of endoleak were analyzed. Results: Pimary endoleak after intervention occurred in 11 patients, of whom, 8 cases were type I, 1 case was type II, and 2 cases were type III; 9 cases underwent bifurcated stent-graft implantation and 2 cases underwent tubular stent-graft implantation. The one type II endoleak was not treated because the leak was small; after first-stage balloon dilatation or stent-graft implantation 2 cases of type I endoleaks still existed, but all the other type I and III endoleaks were resolved. Thirty-nine patients were followed up. During the period of 4 to 50 months of follow-up, 2 delayed type Ib and 2 delayed type II endoleaks were found, but the aneurysms did not enlarge during the following 1- to 2-year follow-up period. The residual primary endoleak in 3 cases spontaneously disappeared, but type Ia endoleak recurred in 1 case 6 months after operation, which caused the aneurysm recurrence and rupture and a second endovascular repair. Conclusion: The occurrence of endoleak is related to anatomic condition, stent defects and surgical skill. Prevention and treatment of endoleaks require a good grasp of surgical indications, reasonable choice of stent, and mature operating experience.