Torsello G, Tessarek J, Kasprzak B, Klenk E
Klinik für Gefässchirurgie, St. Franziskus-Hospital, Münster, Germany.
Dtsch Med Wochenschr. 2002 Jul 5;127(27):1453-7. doi: 10.1055/s-2002-32675.
The treatment of aortic aneurysms is achievable also without laparotomy. With a special technique it is now possible to perform the endovascular aneurysm repair totally percutaneous using an endovascular suture device. With the purpose to reduce the invasiveness of the treatment of abdominal aneurysms, the new technique was used also during procedures requiring large bore devices up to 14-27F. The aim of this retrospective study was to report on results after performing the new technique in 80 patients and on the benefits and limits of its use.
From 1.10.1999 to 31.12.2001, 102 patients with aneurysm disease were treated by endovascular techniques. In 80 cases (68 men, 12 women; mean age 71.3 years) a completely percutaneous procedure was planned. The diameter of the introducer sheaths was 18-27F for the main body of the stent-graft and 14-18F for the contralateral limb. Most patients were operated under spinal anesthesia. Postoperative control included complete physical examination and duplex ultrasound scans.
In 5 of 80 cases the implantation of the endograft could not be performed percutaneously. In 5 of 145 femoral arteries (3.4 %) effective hemostasis could not be achieved. Complications requiring surgery (two pseudoaneurysms, two arterial occlusions) occurred in 4 cases (2.8 %). By duplex ultrasound normal findings were detected in the remaining 136 cases (93,8 %). In 68 of 80 treated patients (85 %) complete percutaneous technique was successful.
Using the preclose-technique it was possible to suture the artery even after using large bore introducer sheaths without cut down. Patient selection, exact puncture technique and accurate use of the device are important factors for success. The technological improvement of the arterial closure devices will allow a more frequent use of the percutaneous technique for aneurysm repair in the future.
主动脉瘤的治疗即便不通过剖腹手术也可实现。借助一项特殊技术，现在能够使用血管内缝合装置完全经皮进行血管内动脉瘤修复术。为降低腹主动脉瘤治疗的侵入性，在需要使用口径达14 - 27F的大口径装置的手术过程中也采用了这项新技术。本回顾性研究的目的是报告80例患者采用新技术后的结果以及其使用的益处和局限性。
1999年10月1日至2001年12月31日，102例动脉瘤疾病患者接受了血管内技术治疗。其中80例（68例男性，12例女性；平均年龄71.3岁）计划采用完全经皮手术。支架移植物主体的导入鞘直径为18 - 27F，对侧肢体的导入鞘直径为14 - 18F。大多数患者在脊髓麻醉下接受手术。术后检查包括全面体格检查和双功超声扫描。
80例中有5例无法经皮植入血管内移植物。145条股动脉中有5条（3.4%）未能实现有效止血。4例（2.8%）出现需要手术处理的并发症（2例假性动脉瘤，2例动脉闭塞）。其余136例（93.8%）经双功超声检查结果正常。80例接受治疗的患者中有68例（85%）完全经皮技术成功。
使用预闭合技术，即便在使用大口径导入鞘后不进行切开也能够缝合动脉。患者选择、精确的穿刺技术以及装置的准确使用是成功的重要因素。动脉闭合装置的技术改进将使经皮技术在未来更频繁地用于动脉瘤修复。
