腹主动脉瘤腔内修复术后短期内漏分析_《中国修复重建外科杂志》

作者：

黄佃 , 周敏 , 刘长建 , 乔彤 , 冉峰

南京大学医学院附属鼓楼医院血管外科（南京，210008）;

关键词：

腹主动脉瘤腔内修复术支架人工血管内漏

DOI：

10.7507/1002-1892.20130294

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的总结腹主动脉瘤（abdominal aorta aneurysm，AAA）患者腔内修复术（endovascular aneurysm repair，EVAR）术后短期内漏发生情况，分析内漏产生原因。方法2005年7月－2013年6月，采用EVAR治疗210例AAA患者。男175例，女35例；年龄42～89岁，平均65.7岁。通过计算机断层扫描动脉造影（computed tomography angiography，CTA）证实为肾下型AAA患者。病程1周～2年，中位病程11.3周。动脉瘤最大直径44～72 mm，平均57.3 mm；锚定区长度均 gt; 1.5 cm。术后2个月常规行CTA复查，了解造影剂内漏情况；如有较明显内漏，于术后6个月再次复查CTA；如仍有明显内漏，行数字剪影血管造影（digital subtraction angiography，DSA），进一步明确内漏性质及程度，必要时采用EVAR修复。结果术中31例患者（14.8%）支架人工血管发生内漏，其中Ⅰ型内漏11例（ⅠA型8例、ⅠB型3例），Ⅱ型内漏18例，Ⅲ型内漏2例（均为ⅢB型）。患者均获随访，随访时间2～8个月，平均3.1个月。术后2 个月复查12例（5.7%）残余动脉瘤腔内有明显造影剂内漏。术后6个月复查仍有10例（4.8%）存在明显内漏，其中8例患者行DSA检查，发现Ⅰ型4例（ⅠA型3例、ⅠB型1例），Ⅱ型3例，Ⅲ型1例。5例Ⅰ、Ⅲ型患者均有不同程度支架人工血管侧突，采用增加延伸移植物支架人工血管方式处理，2～4个月后再次复查CTA显示内漏均消失；Ⅱ型患者未作特殊处理，2个月后再次复查CTA显示内漏仍存在，但动脉瘤最大直径无明显增大。结论支架人工血管侧突是AAA患者EVAR术后短期Ⅰ、Ⅲ型内漏产生的重要原因，可通过再次EVAR封堵内漏。

引用本文： 黄佃,周敏,刘长建,乔彤,冉峰. 腹主动脉瘤腔内修复术后短期内漏分析. 中国修复重建外科杂志, 2013, 27(11): 1355-1358. doi: 10.7507/1002-1892.20130294 复制

1.	Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg, 1991, 5(6): 491-499.
2.	Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet, 2005, 365(9470): 1577-1589.
3.	Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg, 2002, 35(5): 1029-1035.
4.	Fairman RM, Carpenter JP, Baum RA, et al. Potential impact of therapeutic warfarin treatment on type II endoleaks and sac shrinkage rates on midterm follow-up examination. J Vasc Surg, 2002, 35(4): 679-685.
5.	White GH, Yu W, May J. Endoleak—a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg, 1996, 3(1): 124-125.
6.	王深明, 王冕. 主动脉腔内修复术后支架相关并发症分析. 中国血管外科杂志(电子版), 2012, 4(4): 201-205.
7.	中华医学会外科分会血管外科血组. 腹主动脉瘤诊断与治疗指南. 中国实用外科杂志, 2008, 28(11): 916-918.
8.	Peterson BG, Matsumura JS, Brewster DC, et al. Five-year report of a multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysms. J Vasc Surg, 2007, 45(5): 885-890．.
9.	樊昆, 任为. 覆膜支架腔内隔绝和开腹手术治疗腹主动脉瘤破裂疗效比较. 中国修复重建外科杂志, 2012, 26(7): 827-831.
10.	O’Brien G, Martin Z, Haider N, et al. An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy. Ir J Med Sci, 2012, 181(1): 73-76.
11.	Schermerhorn ML, O’Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med, 2008, 358(5): 464-474.
12.	United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, et al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med, 2010, 362(20): 1863-1871.
13.	United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, et al. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med, 2010, 362(20): 1872-1880.
14.	Boyle JR. Long-term outcome of endovascular abdominal aortic aneurysm repair. Br J Surg, 2009, 96(5): 447-448.
15.	蒋米尔, 刘光. 腹主动脉瘤腔内修复面临的挑战和远期疗效研究. 外科理论与实践, 2011, 16(2): 117-121.
16.	郭伟. 腹主动脉瘤腔内修复术: 目前的结果说明了什么？中国血管外科杂志(电子版), 2011, 3(4): 206-208.
17.	Heikkinen MA, Arko FR, Zarins CK. What is the significance of endoleaks and endotensions. Surg Clin North Am, 2004, 84(5): 1337-1352.
18.	Franks SC, Sutton AJ, Bown MJ, et al. Systematic review and meta-analysis of 12 years of endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg, 2007, 33(2): 154-171.
19.	Xenos ES, Stevens SL, Freeman MB, et al. Distribution of sac pressure in an experimental aneurysm model after endovascular repair: the effect of endoleak types I and II. J Endovasc Ther, 2003, 10(3): 516-523.

1. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg, 1991, 5(6): 491-499.
2. Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet, 2005, 365(9470): 1577-1589.
3. Veith FJ, Baum RA, Ohki T, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg, 2002, 35(5): 1029-1035.
4. Fairman RM, Carpenter JP, Baum RA, et al. Potential impact of therapeutic warfarin treatment on type II endoleaks and sac shrinkage rates on midterm follow-up examination. J Vasc Surg, 2002, 35(4): 679-685.
5. White GH, Yu W, May J. Endoleak—a proposed new terminology to describe incomplete aneurysm exclusion by an endoluminal graft. J Endovasc Surg, 1996, 3(1): 124-125.
6. 王深明, 王冕. 主动脉腔内修复术后支架相关并发症分析. 中国血管外科杂志(电子版), 2012, 4(4): 201-205.
7. 中华医学会外科分会血管外科血组. 腹主动脉瘤诊断与治疗指南. 中国实用外科杂志, 2008, 28(11): 916-918.
8. Peterson BG, Matsumura JS, Brewster DC, et al. Five-year report of a multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysms. J Vasc Surg, 2007, 45(5): 885-890．.
9. 樊昆, 任为. 覆膜支架腔内隔绝和开腹手术治疗腹主动脉瘤破裂疗效比较. 中国修复重建外科杂志, 2012, 26(7): 827-831.
10. O’Brien G, Martin Z, Haider N, et al. An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy. Ir J Med Sci, 2012, 181(1): 73-76.
11. Schermerhorn ML, O’Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med, 2008, 358(5): 464-474.
12. United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, et al. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med, 2010, 362(20): 1863-1871.
13. United Kingdom EVAR Trial Investigators, Greenhalgh RM, Brown LC, et al. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med, 2010, 362(20): 1872-1880.
14. Boyle JR. Long-term outcome of endovascular abdominal aortic aneurysm repair. Br J Surg, 2009, 96(5): 447-448.
15. 蒋米尔, 刘光. 腹主动脉瘤腔内修复面临的挑战和远期疗效研究. 外科理论与实践, 2011, 16(2): 117-121.
16. 郭伟. 腹主动脉瘤腔内修复术: 目前的结果说明了什么？中国血管外科杂志(电子版), 2011, 3(4): 206-208.
17. Heikkinen MA, Arko FR, Zarins CK. What is the significance of endoleaks and endotensions. Surg Clin North Am, 2004, 84(5): 1337-1352.
18. Franks SC, Sutton AJ, Bown MJ, et al. Systematic review and meta-analysis of 12 years of endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg, 2007, 33(2): 154-171.
19. Xenos ES, Stevens SL, Freeman MB, et al. Distribution of sac pressure in an experimental aneurysm model after endovascular repair: the effect of endoleak types I and II. J Endovasc Ther, 2003, 10(3): 516-523.

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腹主动脉瘤腔内修复术后短期内漏分析

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《中国修复重建外科杂志》

腹主动脉瘤腔内修复术后短期内漏分析

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