腹主動脈瘤腔內修復術后短期內漏分析_《中國修復重建外科雜志》

作者：

黃佃 , 周敏 , 劉長建 , 喬彤 , 冉峰

南京大學醫學院附屬鼓樓醫院血管外科（南京，210008）;

關鍵詞：

腹主動脈瘤腔內修復術支架人工血管內漏

DOI：

10.7507/1002-1892.20130294

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目的總結腹主動脈瘤（abdominal aorta aneurysm，AAA）患者腔內修復術（endovascular aneurysm repair，EVAR）術后短期內漏發生情況，分析內漏產生原因。方法2005年7月－2013年6月，采用EVAR治療210例AAA患者。男175例，女35例；年齡42～89歲，平均65.7歲。通過計算機斷層掃描動脈造影（computed tomography angiography，CTA）證實為腎下型AAA患者。病程1周～2年，中位病程11.3周。動脈瘤最大直徑44～72 mm，平均57.3 mm；錨定區長度均 gt; 1.5 cm。術后2個月常規行CTA復查，了解造影劑內漏情況；如有較明顯內漏，于術后6個月再次復查CTA；如仍有明顯內漏，行數字剪影血管造影（digital subtraction angiography，DSA），進一步明確內漏性質及程度，必要時采用EVAR修復。結果術中31例患者（14.8%）支架人工血管發生內漏，其中Ⅰ型內漏11例（ⅠA型8例、ⅠB型3例），Ⅱ型內漏18例，Ⅲ型內漏2例（均為ⅢB型）。患者均獲隨訪，隨訪時間2～8個月，平均3.1個月。術后2 個月復查12例（5.7%）殘余動脈瘤腔內有明顯造影劑內漏。術后6個月復查仍有10例（4.8%）存在明顯內漏，其中8例患者行DSA檢查，發現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側突，采用增加延伸移植物支架人工血管方式處理，2～4個月后再次復查CTA顯示內漏均消失；Ⅱ型患者未作特殊處理，2個月后再次復查CTA顯示內漏仍存在，但動脈瘤最大直徑無明顯增大。結論支架人工血管側突是AAA患者EVAR術后短期Ⅰ、Ⅲ型內漏產生的重要原因，可通過再次EVAR封堵內漏。

引用本文： 黃佃,周敏,劉長建,喬彤,冉峰. 腹主動脈瘤腔內修復術后短期內漏分析. 中國修復重建外科雜志, 2013, 27(11): 1355-1358. doi: 10.7507/1002-1892.20130294 復制

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. 主動脈腔內修復術后支架相關并發癥分析. 中國血管外科雜志(電子版), 2012, 4(4): 201-205.
7.	中華醫學會外科分會血管外科血組. 腹主動脈瘤診斷與治療指南. 中國實用外科雜志, 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, 任為. 覆膜支架腔內隔絕和開腹手術治療腹主動脈瘤破裂療效比較. 中國修復重建外科雜志, 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.	蔣米爾, 劉光. 腹主動脈瘤腔內修復面臨的挑戰和遠期療效研究. 外科理論與實踐, 2011, 16(2): 117-121.
16.	郭偉. 腹主動脈瘤腔內修復術: 目前的結果說明了什么？中國血管外科雜志(電子版), 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. 主動脈腔內修復術后支架相關并發癥分析. 中國血管外科雜志(電子版), 2012, 4(4): 201-205.
7. 中華醫學會外科分會血管外科血組. 腹主動脈瘤診斷與治療指南. 中國實用外科雜志, 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, 任為. 覆膜支架腔內隔絕和開腹手術治療腹主動脈瘤破裂療效比較. 中國修復重建外科雜志, 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. 蔣米爾, 劉光. 腹主動脈瘤腔內修復面臨的挑戰和遠期療效研究. 外科理論與實踐, 2011, 16(2): 117-121.
16. 郭偉. 腹主動脈瘤腔內修復術: 目前的結果說明了什么？中國血管外科雜志(電子版), 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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腹主動脈瘤腔內修復術后短期內漏分析

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《中國修復重建外科雜志》

腹主動脈瘤腔內修復術后短期內漏分析

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