近端瘤颈解剖结构不良的腹主动脉瘤腔内修复术

·介入放射学·近端瘤颈解剖结构不良的腹主动脉瘤

腔内修复术

濮欣宁一黄小勇黄杰张庆永黄连军

【摘要】目的分析腔内修复术治疗近端瘤颈解剖结构不良的腹主动脉瘤的安全性及有效性。

方法搜集经主动脉腔内修复的近端瘤颈解剖结构不良腹主动脉瘤患者的临床、影像资料及随访结

果进行回顾性分析。本组患者男135例，女12例；年龄43.0～85.0岁，平均（68.7±8.9岁）；腹主动脉瘤

最大径45～100mm，瘤颈长度7～32mm、直径15～30mm、成角10°～90°、瘤颈部动脉硬化改变43

例。术后3、6、12个月及以后每年随访1次。随访内容为患者临床情况，主动脉CT血管成像结果（覆

膜支架形态、位置，动脉瘤形态变化及瘤腔血栓化情况、内漏情况等）。结果147例患者手术均成

功。120例采用常规腹主动脉覆膜支架植入术，术后即刻Ⅰa型内漏32例，其中25例于近端球囊扩张

后内漏消失，7例近端加用覆膜支架延长支（Cuff）后内漏消失。3例采用开窗技术定制支架，24例加用

肾动脉烟囱技术。随访6～42个月，中位时间18个月，累计生存率98.0%（144/147），随访期间支架通

畅率99.3%（146/147），瘤腔血栓化率97.3%（143/147）。随访期间3例死亡，2例瘤体破裂、1例原因不

明；1例单侧髂支内血栓形成致管腔闭塞，1例持续Ⅲ型内漏，均行二次介入手术成功。未见支架移

位、下肢缺血、感染等严重并发症。结论腔内修复术治疗近端瘤颈解剖结构不良的腹主动脉瘤安

全、有效。根据动脉瘤具体情况选择支架、多种腔内修复技术联合应用及密切的随访是关键。

【关键词】主动脉瘤，腹；血管成形术

Endovascular repair of abdominal aortic aneurysm with hostile proximal neck anatomy Pu Xin,

Ning Yi,Huang Xiaoyong,Huang Jie,Zhang Qingyong,Huang Lianjun.*Interventional Department,Beijing

Anzhen Hospital,Capital Medical University,Beijing100029,China

Corresponding author:Huang Lianjun,Email:huanglianjun@

【Abstract】Objective To analyze the safety and efficacy of endovascular aortic repair(EVAR)for abdominal aortic aneurysm(AAA)with hostile aortic proximal landing anatomy.Methods The clinical and

imaging data of147AAA patients[135males,(68.7±8.9)years old,range43-85years old]with hostile

aortic proximal landing anatomy treated by EVAR from January2012to December2014in our center were retrospectively analyzed.The range of maximum aneurysm diameter was45-100mm;the length range of

proximal aneurysm neck was7-32mm;the width range of proximal aneurysm neck was15-30mm,and the

infrarenal angulation was10°-90°.In addition,there were atherosclerotic changes in the proximal neck in

43cases.Follow-up protocol consisted of evaluation of clinical symptoms and cTA at3,6and12months and

annually thereafter.Results The technical success rate was100%.Different procedures were adopted

among patients,with113cases of EVAR,3cases of fenestrated EVAR and24cases of chimney EVAR.The

intra-operative type Ia endoleak was observed in32cases,in which25of them were successfully treated by

balloon angioplasty and the other9patients were treated with Cuff extension.During the mean follow-up

period of18months(6-42months),the accumulative survival rate was98.0%(144/147)，the patency rate of

stents was99.3%(146/147),and the thrombosis rate of aneurysm was97.3%(143/147).Two patients died

because of aneurysm rupture,and another case died of unknown reason.Two patients underwent secondary intervention successfully for the treatment of thrombosis formation and lumen occlusion in unilateral iliac

stent in1case,and typeⅢendoleak in another case.No other complications such as misplace of stent

grafts,no bilateral limb ischemia and stent infection were observed during follow-up.Conclusions EVAR

DOI:10.3760/cma.j.issn.1005-1201.2017.01.010

作者单位：100029首都医科大学附属北京安贞医院介入诊疗科

通信作者：黄连军，Email：huanglianjun@