白塞病并发动脉瘤12例的外科治疗体会

目的总结白塞病并发动脉瘤的外科手术和腔内治疗经验。方法对1977年6月至2006年3月收治的12例白塞病患者并发21个动脉瘤进行回顾性分析。腹主动脉瘤3个,升主动脉瘤1个,髂动脉瘤4个,髂动脉吻合口假性动脉瘤1个,股总动脉瘤3个,股浅动脉瘤2个,腘动脉瘤2个,椎动脉瘤1个,锁骨下动脉瘤2个。颈动脉瘤1个和肠系膜上动脉瘤1个。21个动脉瘤中,行外科手术14个,包括动脉瘤切除、人工血管或自体大隐静脉移植术12个,动脉瘤切除、病变动脉结扎术2个;行支架型人工血管腔内修复术6个;1个升主动脉瘤因患者全身情况差,行保守治疗。结果围手术期死亡患者2例,其中1例行外科手术,1例行腔内修复术。术后吻合口假性动脉瘤1例（1个）,其他部位新动脉瘤形成7个,下肢血管移植物闭塞2例,但患肢无明显缺血坏死。6例患者随访3-293个月,随访中位时间28个月,1例死于肺癌。结论白塞病动脉瘤一旦发生,需积极处理。术前、术后积极免疫抑制治疗可降低外科手术和腔内修复术后并发症发生。因术后有吻合口和其他部位假性动脉瘤复发及血管移植物闭塞可能,需长期随访、及时处理。

Experiences in the management of aneurysm in Behcet disease

Objective To report our experiences in the surgical and endovascular treatment of arterial aneurysms in patients with Behcet disease. Methods There were 21 arterial aneurysms in 12 Behcet patients diagnosed between June 1977 and March 2006 which were retrospectively analyzed. There were three abdominal aortic, one ascending aortic, four iliac, one iliac anastomotic, three common femoral, two superficial femoral, two popliteal, one vertebral, two subclavian, one carotid and one superior mesenteric artery aneurysm. Surgical procedures included aneurysmectomy and prosthetic or autologous saphenous vein graft replacement in 12 cases, aneurysmectomy and diseased artery ligation in 2 cases. Endovascular exclusion with stent graft were successfully performed in 6 cases. Conservative treatment was given to 1 ascending aortic aneurysm due to the poor condition of the patient. Results There were 2 deaths during the perioperative period, 1 death after surgical operation and 1 after endoluminal exclusion. There was 1 anastomotic pseudoaneurysm occurrence, 7 new aneurysms formation and 2 grafts occlusion, resulting in no significant ischemia of involved extremities. Six patients were followed up for a median duration of 28 months ( ranged 3 to 293 months) , 1 patient died of lung cancer. Conclusion Behcet aneurysm is required to be managed immediately once it occurs because of its life-threatening complications. Remission of Behcet disease before and after intervention can decrease the incidence of posprocedural complication. Because pseudoaneurysm occurrence at the site of anastomosis, development of new aneurysms at other arteries and occlusion of vascular graft are possible, prolonged follow-up and monitoring are necessary.