国产一体式分叉型覆膜支架治疗腹主动脉瘤的临床评价

目的探讨国产一体式分叉型覆膜支架治疗腹主动脉瘤的临床疗效、并发症的防治、术中注意事项。方法对14例经CTA检查确诊腹主动脉瘤的患者,给予一体式分叉型覆膜支架植入行腔内隔绝术。结果 14例手术成功,其中有3例造影示有上端Ⅰ型内漏,1例安置Cuff,内漏消失。另2例3个月后复查CTA,内漏消失。所有病例无严重并发症,随访2年,支架位置、形态良好,无移位、内漏。结论 一体式分叉型覆膜支架腔内治疗腹主动脉瘤具有成功率高、创伤小、恢复快等特点,且手术更简便,支架稳定性更高。     

腔内隔绝术治疗胸腹主动脉瘤的临床应用

目的探讨腔内隔绝术治疗胸腹主动脉瘤的疗效和安全性。方法2000年5月～2004年10月,采用腔内隔绝术治疗胸腹主动脉瘤7例,其中4例胸主动脉夹层动脉瘤、1例胸主动脉假性动脉瘤、2例肾下型腹主动脉瘤,术后随访采用彩超和增强CT检查。结果7例病人共成功置入10个支架。随访2～28个月,所有支架位置、形态正常。4例胸主动脉夹层动脉瘤的内膜破裂口封闭,胸降主动脉和腹主动脉真腔扩大,假腔内血栓形成。1例胸主动脉假性动脉瘤和2例肾下型腹主动脉瘤的瘤体缩小。2例术后出现微小内漏,分别在2个月、6个月后内漏自行封闭,1例术后出现髂外动脉夹层经PTA和Wallstent治疗。结论腔内隔绝术能有效治疗胸腹主动脉瘤,具有创伤小、疗效确切和并发症少等优点。     

覆膜支架腔内隔绝术治疗DabekeyⅢ型主动脉夹层动脉瘤16例

目的观察分析DabekeyⅢ型主动脉夹层动脉瘤经覆膜支架腔内隔绝术治疗的临床可行性与术后效果。方法选取临床16例DabekeyⅢ型主动脉夹层动脉瘤患者,这些患者均行覆膜支架腔内隔绝术。于术后3、6、12个月随访观察并发症发生及存活情况。结果 16例手术均成功,随访率81%,其中1例因堵闭左颈总动脉急行右锁骨下动脉-左颈总动脉人工血管搭桥术,术后未出现脑血管并发症;4例内漏,其中1例为分叉支架由于内漏不闭合术后6个月再行支架术,其余3例于术后3个月自行闭合。随访中1例死亡(心源性猝死)。结论覆膜支架腔内隔绝术治疗DabekeyⅢ型主动脉夹层动脉瘤安全、可靠。     

覆膜支架腔内隔绝术治疗Stanford B型主动脉夹层10例的护理

目的探讨10例覆膜支架腔内隔绝术治疗StanfordB型主动脉夹层的护理经验。方法回顾性分析10例经股动脉置管覆膜支架腔内隔绝术治疗StanfordB型主动脉夹层的临床资料,探讨覆膜支架腔内隔绝术治疗StanfordB型主动脉夹层的护理。结果所有患者术后2周复查CTA,显示支架位置良好,无移位、扭曲;术后3个月复查,1例出现轻度内漏,无胸背部疼痛等症状,术后6个月再次复查内漏自行闭合。结论覆膜支架腔内隔绝术是治疗StanfordB型主动脉夹层安全、有效的治疗手段,术前全面准备和术后精心护理对于保证手术成功,降低病死率十分重要。     

腹主动脉瘤腔内修复术后二次手术的原因分析

目的分析腹主动脉瘤腔内修复术(EVAR)患者术后进行二次手术的原因。方法回顾性分析行EVAR治疗的171例肾下型腹主动脉瘤(AAA)患者的临床资料和随访结果,其中20例患者接受二次手术干预。分析二次手术的原因,并探讨如何减少EVAR术后并发症的发生。结果20例二次手术患者中,Ⅰ型内漏8例(Ⅰa型6例、Ⅰb型2例),Ⅱ型内漏2例(肠系膜下动脉返血),Ⅲ型内漏2例(左髂支回缩入瘤腔),左侧髂支血栓阻塞致主体支架内血栓形成2例,髂支血栓形成4例,髂支狭窄2例。回归分析结果显示,术后内漏、远端缺血是EVAR患者术后进行二次手术的主要原因。根据动脉瘤的瘤体情况选择不同的腔内修复手术,术后按时随访是提高患者手术安全性及治疗效率的关键。结论EVAR手术的近期疗效良好,但术后内漏及远端缺血等问题仍是影响手术疗效的关键,患者可能因此进行二次手术。     

适用于腔内隔绝移植物及血流动力学研究的犬肾周型腹主动脉瘤模型的建立

建立一种适用于研究腔内隔绝移植物及血流动力学的犬肾周型腹主动脉瘤模型。方法通过在犬近肾腹主动脉段移植经0.6%戊二醛浸泡30min去抗原处理后的牛颈外静脉,制作15例犬肾周型腹主动脉瘤模型。将此动脉瘤模型与患者的肾周型腹主动脉瘤进行形态学的相比,并且检测血流动力学参数并与15例腹主动瘤患者对比。结果15只动物手术过程顺利,术中死亡0只,术后1天腹腔出血死亡1只,术后2天急性肾衰死亡3只。动物模型与肾周型腹主动脉瘤患者动脉瘤形态相似。直径、壁厚的比例相似。瘤体内收缩压、舒张压、平均动脉压均高于肾上腹主动脉、髂总动脉和动脉瘤入、出口。动脉壁弹性相似。动脉瘤中都出现了涡流或湍流。结论此模型是适合肾周型腹主动脉瘤腔内隔绝移植物及血流动力学研究有较大实用坐和动物模型。     

交叉腿技术在近端瘤颈扭曲腹主动脉瘤腔内修复术中应用长期疗效研究

目的 观察交叉腿技术在近端瘤颈扭曲的腹主动脉瘤腔内修复术中应用的长期临床疗效.方法 收集自2014年9月至2020年8月北部战区总医院心血管内科收治的5例近端瘤颈扭曲的腹主动脉瘤患者临床资料,患者均采用腔内修复术治疗,并将交叉腿覆膜支架植入.出院后,对患者进行随访并观察患者远期临床疗效.随访时间为术后1、3、6个月及术后1年,1年后每年随访1次.随访内容包括存活状态及新发冠心病、脑血管病、肾功能不全、心律失常、内漏、动脉瘤破裂或夹层等.结果 5例患者手术均成功.患者无围术期死亡;无穿刺口或切口延迟愈合、腹主动脉瘤破裂、发热等腔内修复术术后表现;无肾功能不全等并发症发生.5例患者随访时间(42±30)个月,均存活.其中,1例患者于术后65个月出现腹痛,复查腹主动脉CT血管造影显示,腹主动脉下段支架外壁间血肿形成,考虑腹膜后血肿形成,经保守治疗,无腹部不适.其余4例患者均无腹痛不适,无内漏及支架内血栓形成,无动脉瘤破裂或夹层等.结论 交叉腿技术在近端瘤颈扭曲的腹主动脉瘤患者腔内修复术中应用安全,长期疗效较好.     

腹主动脉瘤行腔内隔绝术的手术配合

[目的]总结腹主动脉瘤行腔内隔绝术的手术配合。[方法]对37例腹主动脉瘤病人行腔内隔绝术,同时给予密切护理配合。[结果]37例病人均成功行 EVG手术,其中分叉型覆膜支架33例和直筒型覆膜支架（4例）,手术均顺利,术毕造影均未见明显Ⅰ型内漏、血管出血或支架移位等并发症;术后病人均康复出院。[结论]加强腹主动脉瘤行腔内隔绝术的手术配合是手术成功的保证。     

三分叉覆膜支架血管治疗A型主动脉瘤夹层手术的护理配合

目的探讨三分叉覆膜支架血管治疗A型主动脉瘤夹层手术的护理配合。方法对19例行三分叉覆膜支架血管治疗A型主动脉瘤夹层患者进行术前护理包括做好访视、健康教育,备齐手术用物和术中配合包括麻醉、体位摆放、根据手术需要调节手术间温度、做好皮肤和管道等护理。结果 19例患者手术顺利。住院15~36 d,平均25.5 d。术后随访1~4个月,19例患者的主动脉弓部及头臂动脉内支架扩张贴壁满意,相应部位假腔消失或血栓填塞。无与支架覆膜血管相关的并发症。结论对三分叉覆膜支架血管治疗A型主动脉瘤夹层这类特大手术,充分的术前准备、熟练的术中配合及术后访视有利于手术的顺利实施,有利患者康复。     

下行双导丝技术在复杂腹主动脉瘤腔内治疗中的应用

目的 探讨下行双导丝技术在复杂腹主动脉瘤腔内隔绝术（EVAR）中操作要点和应用价值.方法 回顾2007年7月至2011年10月14例复杂腹主动脉患者采用下行双导丝技术经双侧股动脉植入覆膜支架,对腹主动脉瘤进行腔内支架治疗.结果 14例手术获成功,手术时间为2～3 h,其中1例术后出现单侧下肢缺血：随访3～24月,14例均生存良好,未发生支架移位、严重内漏及肾功能衰竭等严重并发症.结论 下行双导丝技术在腔内支架治疗复杂解剖形态腹主动脉瘤中,具有操作时问短、操作容易、安全性高等优点,值得推广.     

Experience with the Endologix Powerlink endograft in endovascular repair of abdominal aortic aneurysms with short and angulated necks

Endovascular aortic aneurysm repair (EVAR) for anatomically suitable abdominal aortic aneurysms (AAAs) has gained wide acceptance in the past decade, and EVAR for anatomically challenging or unsuitable AAAs such as short and angulated neck AAAs has become a hotly debated subject. The objective of this study is to summarize the unique experience of EVAR for short / angulated neck AAAs with Powerlink unibody bifurcated stent-graft. Data were retrospectively analyzed from 519 patients in our single unit from February 1999 to December 2007 who underwent EVAR using the Powerlink endograft, and had short or angulated necks. Short neck was defined as < or = 15 mm for the infrarenal neck length, and it was divided into 2 groups: Group A (short neck), 54 cases with the length 11 to 15 mm; and Group B (very short neck), 26 cases with the length < or = 10 mm. Angulated neck of 37 cases which was defined as > or = 60 degrees angulation between the longitudinal axis of infrarenal aorta and the aneurysm. The unique strategy of treating short / angulated neck AAAs is to build up the endoluminal exclusion system from the native aortic bifurcation to the renal artery level with suprarenal fixation. The Powerlink unibody bifurcated stent graft was implanted anatomically fixed on the aortic bifurcation and a long suprarenal cuff was built up to the renal arteries. A Palmaz stent can be used for proximal fixation and sealing enhancement in the most challenging necks. The follow-up imaging was performed at 1 month, 6 months, and yearly thereafter. The technical success rate was 97.4% (114/117). Intraoperative complications included 3 conversions due to delivery access problems, 6 proximal type I endoleaks, and 5 type II endoleaks. The 30-day mortality was 1.7% (2/117). The 2.6-year follow-up showed 4 (3.4%) proximal type I endoleaks, which were revised with proximal cuff and/or Palmaz stent. Limb occlusion occurred in 2 cases, and the total re-intervention rate was 5.3%. Three (2.6%) type II endoleaks were left in observation. There were 3 (2.6%) partial renal infarctions, no stent-graft distal migration, and no post-EVAR ruptures. Our experience demonstrates that building up the endoluminal exclusion system from the abdominal aortic bifurcation to the renal artery level using the Powerlink fully supported unibody bifurcated stent-graft with a long suprarenal cuff, and a Palmaz stent when needed, proved safe and effective in treating AAAs with short and angulated necks.     

Endovascular therapy for aortic aneurysm

Recently minimally invasive endovascular therapy using a stent graft has made significant advances in the treatment of aortic aneurysm. Eventually, five kinds of stent grafts were commercial available in Japan for the thoracic and abdominal aortic aneurysm with acceptable outcomes. Initial results of stent graft are superior than those of open surgery in many cases, but further investigation for endoleak and sac behavior should attempt to determine its efficacy over a longer follow-up period.     

腹主动脉瘤腔内修复治疗的进展

腹主动脉瘤（Abdominal aortic aneurysm,AAA）是指腹主动脉局限性瘤样扩张,超过3cm或超过正常直径的50%即可诊断为腹主动脉瘤,75%的患者并无临床症状〔1〕,破裂是其最常见、最凶险的并发症,破裂后的死亡率高达80%~90%〔2〕。     

6例胸腹主动脉夹层的腔内隔绝术治疗

目的探讨腔内隔绝术治疗胸腹主动脉夹层的经验和效果。方法 4例胸主动脉夹层和2例腹主动脉夹层病人接受腔内隔绝术治疗,术前均行彩超、三维重建螺旋CT、MRI等检查确诊。结果术后DSA造影显示：6例动脉夹层消失,覆膜支架近远端与主动脉结合处无内漏,支架无移位。术后3～6个月彩超及CT随访显示腔内覆膜支架无移位及内漏。结论腔内隔绝术是一种创伤小、并发症少的治疗胸腹主动脉夹层的安全、有效的方法。     

Late‐onset type I endoleak characterized by contrast enhanced ultrasound after endovascular repair of aortic aneurysm

We report in the case of a patient with an intra‐abdominal aortic aneurysm treated with endovascular aneurysm repair (EVAR) who developed renal impairment during the period of follow up. The repair was complicated with an early‐onset type II endoleak which later evolved into a late‐onset type I endoleak. It was treated with proximal extension of stent graft, with treatment success and follow‐up documented on contrast enhanced ultrasound (CEUS). This case illustrates the usefulness of CEUS in post‐EVAR surveillance and emphasizes the need for life‐long monitoring as late‐onset complications are not uncommon.     

Histology and electron microscopy of explanted bifurcated endovascular aortic grafts: evidence of early incorporation and healing.

PURPOSE: To report an examination of explanted bifurcated endovascular aortic grafts for histologic evidence of early healing and incorporation. METHOD: Two bifurcated endovascular aortic grafts composed of polycarbonate urethane and Elgiloy wire were explanted 42 and 21 days after successful endovascular exclusion of abdominal aortic aneurysms. Both patients expired from causes unrelated to endograft deployment. The explanted devices were examined using immunohistochemical analysis and electron microscopy. RESULTS: On explantation, both grafts appeared to have excluded the aneurysm with no evidence of endoleak, graft migration, or thrombosis. Histological examination showed numerous inflammatory cells and good ingrowth of tissue into the proximal 2 cm of the graft. Collagen and smooth muscle cells were evident in the proximal portion of the graft with only collagen in the distal segments. Neointimal formation was seen within the proximal 2 cm also, but not at the distal segments. Macrophages were present in the graft. Scanning electron microscopy showed an extensive matrix of fibers that most likely represented collagen. CONCLUSIONS: Bifurcated endovascular aortic grafts show inflammatory and mild foreign body reactions, collagen formation, and intimal ingrowth during healing. These findings are similar to some of the healing properties reported for sutured grafts, as well as other endovascular grafts.