应用一体式分叉支架型人工血管腔内治疗腹主动脉瘤42例

目的总结应用一体式分又支架型人工血管治疗腹主动脉瘤初步经验。方法本组42例，其中腹主动脉瘤39例，腹主动脉假性动脉瘤1例，Ⅲ型夹层动脉瘤1例，降主动脉瘤合并腹主动脉瘤1例。除均在腹主动脉放置一体式分又支架型人工血管外，1例降主动脉瘤合并腹主动脉瘤者共放置5枚支架型人工血管，其中4枚直型支架用于隔绝降主动脉瘤；1例Ⅲ型夹层动脉瘤者，降主动脉近侧破口用直型支架型人工血管封堵；1例因一侧髂外动脉闭塞需先经腹膜外切口行人工血管搭桥后才能放置一体式分叉支架。结果平均手术时间50min。1例死亡，8例附加近侧短的覆膜支架，1例附加远侧Cuff，1例近侧和远侧均加Cuff。8例术后有少量内漏，1周后内漏均消失。5例封堵了双侧髂内动脉，20例封堵了单侧髂内动脉，但均未导致臀肌坏死或疼痛等并发症。2例瘤颈与瘤体呈90度角也获得成功。结论一体式分又支架型人工血管可以达到隔绝腹主动脉瘤的作用，且操作更快捷。

Endovascular treatment of abdominal aortic aneurysm with unibody bifurcation stent-graft in 42 cases

Objective To sum up our preliminary experience for the treatment of abdominal aortic aneurysm ( AAA) using unibody bifurcation stent-graft ( UBST). Methods This study included 42 cases, among them there were 39 AAA cases, one case of abdominal aortic pseudoanrurysm (AAPA) , one case of type C dissecting aortic aneurysm, one descending aortic aneurysm (DAA) with AAA. Five stent-grafts were deployed for the case with DAA and AAA including 4 stent-grafts were used for DAA and one UBST for AAA. For the case of type C dissecting aortic aneurysm, one straight stent-graft was used for sealing the proximal intimal tear, one UBST was deployed for sealing the distal intimal tear. A graft bypass was required in the case with AAPA through extraperitoneal incision occlusion of external iliac artery of one side, then an UBST was deployed for sealing the rupture of abdominal aorta. Results The average operative time was 50 minutes. One patient died. One more proximal cuff was required in 8 cases. One more distal cuff was required in one case, one more proximal and distal cuff respectively were required in one case. Postoperative transient slight leakage was present in 8 cases. Both internal iliac arteries were sealed in 5 cases; unilateral internal iliac artery was sealed in 20 cases. Success was reached in two cases with an angle of 90 degress between aneurismal neck and body. Conclusion The exclusion of AAA using UBST is successful and safe.