血管腔內介入與開放手術治療外周假性動脈瘤的療效比較_《中國修復重建外科雜志》

作者：

王開振 , 任為 , 成軍 , 趙渝

重慶醫科大學附屬第一醫院血管外科（重慶，400016）;

關鍵詞：

外周假性動脈瘤血管腔內介入術開放手術

DOI：

10.7507/1002-1892.20130192

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目的比較血管腔內介入與開放手術治療外周假性動脈瘤的療效，為臨床選擇恰當術式提供參考。方法回顧分析2001年1月－2012年1月接受開放或血管腔內介入手術治療并符合選擇標準的62例外周假性動脈瘤患者臨床資料，根據術式不同分為兩組，其中開放手術治療34例（開放組），血管腔內介入治療28例（介入組）。兩組患者性別、年齡、致傷原因、動脈瘤部位及瘤體直徑比較，差異均無統計學意義（P gt; 0.05），具有可比性。結果介入組患者手術時間、術中出血量、ICU監護時間及住院時間均低于開放組，比較差異有統計學意義（P lt; 0.05）。開放組術后早期12例（35.29%）發生并發癥，其中因急性呼吸窘迫綜合征死亡2例，肺部感染5例，切口感染3例，深靜脈血栓形成2例；介入組2例（7.14%）發生并發癥，其中穿刺點血腫1例，支架內血栓1例。兩組術后早期并發癥發生率比較，差異有統計學意義（χ2=6.691，P=0.008）。患者術后均獲隨訪，隨訪時間12～39個月，平均26個月。術后12個月開放組與介入組血管通暢率分別為96.88%（31/32）、92.86%（26/28），比較差異無統計學意義（χ2=0.014，P=0.905）；術后24個月血管通暢率分別為89.29%（25/28）、84.00%（21/25），差異亦無統計學意義（χ2=0.322，P=0.570）。結論與開放手術相比，血管腔內介入治療外周假性動脈瘤具有微創、術中出血少、住院時間短、并發癥少等優點，近期療效較好。但介入術后需長時間的抗血小板治療，遠期效果仍需進一步觀察。

引用本文： 王開振,任為,成軍,趙渝. 血管腔內介入與開放手術治療外周假性動脈瘤的療效比較. 中國修復重建外科雜志, 2013, 27(7): 876-880. doi: 10.7507/1002-1892.20130192 復制

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2.	Halvorson JJ, Anz A, Langfitt M, et al. Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg, 2011, 19(8): 495-504.
3.	Puech-Leão P, Wolosker N, Zerati AE, et al. Impact of endovascular technique in vascular surgery training at a large university hospital in Brazil. J Surg Educ, 2011, 68(1): 19-23.
4.	Wolosker N, Mendes Cde A, Jacob CE, et al. Endovascular infrarenal aortic aneurysm repair combined with laparoscopic cholecystectomy. Clinics (Sao Paulo), 2010, 65(7): 743-744.
5.	宋超, 陸清聲, 洪毅, 等. 開放手術及腔內隔絕術治療內臟動脈瘤對照研究. 中華普通外科雜志, 2012, 27(7): 543-545.
6.	du Toit DF, Coolen D, Lambrechts A, et al. The endovascular management of penetrating carotid artery injuries: long-term follow-up. Eur J Vasc Endovasc Surg, 2009, 38(3): 267-272.
7.	Ferreira J, Canedo A, Brandão D, et al. Isolated iliac artery aneurysms: six-year experience. Interact Cardiovasc Thorac Surg, 2010, 10(2): 245-248.
8.	DuBose JJ, Rajani R, Gilani R, et al. Endovascular management of axillo-subclavian arterial injury: a review of published experience. Injury, 2012, 43(11): 1785-1792.
9.	Reed AB. Advances in the endovascular management of acute injury. Perspect Vasc Surg Endovasc Ther, 2011, 23(1): 58-63.
10.	Papazoglou KO, Sfyroeras GS, Zambas N, et al. Outcomes of endovascular aneurysm repair with selective internal iliac artery cover age without coil embolization. J Vasc Surg, 2012, 56(2): 298-303.
11.	Garg K, Rockman CB, Kim BJ, et al. Outcome of endovascular repair of popliteal artery aneurysm using the Viabahn endoprosthesis. J Vasc Surg, 2012, 55(6): 1647-1653.
12.	Ruffino MA, Rabbia C, Italian Cardiatis Registry Investigators Group. Endovascular treatment of visceral aneurysms with Cardiatis multilayer flow modulator: preliminary results at six-months follow up. J Cardiovasc Surg (Torino), 2011, 52(3): 311-322.
13.	Danetz JS, Cassano AD, Stone MC, et al. Feasibility of endovascular repair in penetrating axillosubclavian injuries: a retrospective review. J Vase Surg, 2005, 41(2): 246-254.
14.	Patel NV, Long GW, Cheema ZF, et al. Open vs. endovascular repair of isolated iliac artery aneurysms: a 12-year experience. J Vasc Surg, 2009, 49(5): 1147-1153.
15.	Pitoulias GA, Donas KP, Schulte S, et al. Isolated iliac artery aneurysms: endovascular versus open elective repair. J Vasc Surg, 2007, 46(4): 648-654.
16.	Starnes BW, Arthurs ZM. Endovascular management of vascular trauma. Perspect Vasc Surg Endovasc Ther, 2006, 18(2): 114-129.
17.	White PW, Gillespie DL, Feurstein I, et al. Sixty-four slice multidetector computed tomographic angiography in the evaluation of vascular trauma. J Trauma, 2010, 68(1): 96-102.
18.	Cinà CS, Moore R, Maggisano R, et al. Endovascular repair of popliteal artery aneurysms with Anaconda limbs: technique and early results. Catheter Cardiovasc Interv, 2008, 72(5): 716-724.
19.	Tielliu IF, Zeebregts CJ, Vourliotakis G, et al. Stent fractures in the Hemobahn /Viabahn stent graft after endovascular popliteal aneurysm repair. J Vasc Surg, 2010, 51(6): 1413-1418.

1. Wolosker N, Oba CM, Espirito Santo FR, et al. Endovascular treatment for chronic arteriovenous fistula between renal artery and inferior vena cava: image in vascular surgery. Vasc Endovascular Surg, 2010, 44(6): 489-490.
2. Halvorson JJ, Anz A, Langfitt M, et al. Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg, 2011, 19(8): 495-504.
3. Puech-Leão P, Wolosker N, Zerati AE, et al. Impact of endovascular technique in vascular surgery training at a large university hospital in Brazil. J Surg Educ, 2011, 68(1): 19-23.
4. Wolosker N, Mendes Cde A, Jacob CE, et al. Endovascular infrarenal aortic aneurysm repair combined with laparoscopic cholecystectomy. Clinics (Sao Paulo), 2010, 65(7): 743-744.
5. 宋超, 陸清聲, 洪毅, 等. 開放手術及腔內隔絕術治療內臟動脈瘤對照研究. 中華普通外科雜志, 2012, 27(7): 543-545.
6. du Toit DF, Coolen D, Lambrechts A, et al. The endovascular management of penetrating carotid artery injuries: long-term follow-up. Eur J Vasc Endovasc Surg, 2009, 38(3): 267-272.
7. Ferreira J, Canedo A, Brandão D, et al. Isolated iliac artery aneurysms: six-year experience. Interact Cardiovasc Thorac Surg, 2010, 10(2): 245-248.
8. DuBose JJ, Rajani R, Gilani R, et al. Endovascular management of axillo-subclavian arterial injury: a review of published experience. Injury, 2012, 43(11): 1785-1792.
9. Reed AB. Advances in the endovascular management of acute injury. Perspect Vasc Surg Endovasc Ther, 2011, 23(1): 58-63.
10. Papazoglou KO, Sfyroeras GS, Zambas N, et al. Outcomes of endovascular aneurysm repair with selective internal iliac artery cover age without coil embolization. J Vasc Surg, 2012, 56(2): 298-303.
11. Garg K, Rockman CB, Kim BJ, et al. Outcome of endovascular repair of popliteal artery aneurysm using the Viabahn endoprosthesis. J Vasc Surg, 2012, 55(6): 1647-1653.
12. Ruffino MA, Rabbia C, Italian Cardiatis Registry Investigators Group. Endovascular treatment of visceral aneurysms with Cardiatis multilayer flow modulator: preliminary results at six-months follow up. J Cardiovasc Surg (Torino), 2011, 52(3): 311-322.
13. Danetz JS, Cassano AD, Stone MC, et al. Feasibility of endovascular repair in penetrating axillosubclavian injuries: a retrospective review. J Vase Surg, 2005, 41(2): 246-254.
14. Patel NV, Long GW, Cheema ZF, et al. Open vs. endovascular repair of isolated iliac artery aneurysms: a 12-year experience. J Vasc Surg, 2009, 49(5): 1147-1153.
15. Pitoulias GA, Donas KP, Schulte S, et al. Isolated iliac artery aneurysms: endovascular versus open elective repair. J Vasc Surg, 2007, 46(4): 648-654.
16. Starnes BW, Arthurs ZM. Endovascular management of vascular trauma. Perspect Vasc Surg Endovasc Ther, 2006, 18(2): 114-129.
17. White PW, Gillespie DL, Feurstein I, et al. Sixty-four slice multidetector computed tomographic angiography in the evaluation of vascular trauma. J Trauma, 2010, 68(1): 96-102.
18. Cinà CS, Moore R, Maggisano R, et al. Endovascular repair of popliteal artery aneurysms with Anaconda limbs: technique and early results. Catheter Cardiovasc Interv, 2008, 72(5): 716-724.
19. Tielliu IF, Zeebregts CJ, Vourliotakis G, et al. Stent fractures in the Hemobahn /Viabahn stent graft after endovascular popliteal aneurysm repair. J Vasc Surg, 2010, 51(6): 1413-1418.

《中國修復重建外科雜志》

血管腔內介入與開放手術治療外周假性動脈瘤的療效比較

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《中國修復重建外科雜志》

血管腔內介入與開放手術治療外周假性動脈瘤的療效比較

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