联合股-股动脉旁路移植术的单臂支架腔内修复腹主动脉瘤的经验

目的探讨联合股-股动脉旁路移植术(cross-femoral bypass grafting,CFBG)的单臂支架型血管(aortouniiliac,AUI)腔内修复腹主动脉瘤(endovascular aneurysm repair,EVAR)的疗效。方法1997年5月~2007年2月,对8例因髂动脉的特殊解剖条件无法应用分叉支架型血管的腹主动脉瘤采用联合CFBG的AUI支架型血管进行EVAR治疗。术后观察内漏、缺血并发症、股股旁路血管的通畅性以及下肢血供情况等。结果围手术期无死亡,1例因急性心肌梗死于术后15个月死亡。3例原发性内漏分别于术后1、3、6个月自愈。8例平均随访24个月(3~72个月),旁路均通畅,1例于术后1年吻合口轻微狭窄但无下肢缺血症状。结论因髂动脉解剖条件复杂不能应用分叉支架型血管的腹主动脉瘤采用联合CFBG的AUI支架型血管进行EVAR是安全、有效的。

Experiences on Endovascular Aortouniiliac Repair Combined with Cross-Femoral Bypass Grafting for Abdominal Aortic Aneurysm

Objective To evaluate the efficacy of endovascular aortouniiliac repair (EVAR) combined with cross-femoral bypass grafting (CFBG) for the treatment of abdominal aortic aneurysm (AAA). Methods From May 1997 to February 2007, 8 patients with AAA, in whom bifurcated stent-graft could not be used because of complex iliac anatomy, were treated with EVAR using AUI stent-graft combined with CFBG. The endoleak, ischemic syndromes,patency of the bypasses, and blood supply of the lower limbs were observed after the operation. Results There were no perioperative mortalities in this series. One patient died of myocardial infarction 15 months after the operation. Three patients developed primary endoleak, and was cure spontaneously 1, 3, and 6 months postoperation. The 8 patients were followed up for a mean of 24 months (3-72 months), during which the patency rate of cross-femoral bypass was 100%. One year after the operation, 1 patient developed mild anastomotic stoma stenosis without ischemia of the lower limbs, but no limb ischemia. Conclusion In patients with complex iliac anatomy unfavorable for bifurcated endografting, EVAR using AUI combined with CFBG is safe and effective.