Parodi J C, Palmaz J C, Barone H D
Department of Vascular Surgery, Instituto Cardiovascular de Buenos Aires, Argentina.
Ann Vasc Surg. 1991 Nov;5(6):491-9. doi: 10.1007/BF02015271.
This study reports on animal experimentation and initial clinical trials exploring the feasibility of exclusion of an abdominal aortic aneurysm by placement of an intraluminal, stent-anchored, Dacron prosthetic graft using retrograde cannulation of the common femoral artery under local or regional anesthesia. Experiments showed that when a balloon-expandable stent was sutured to the partially overlapping ends of a tubular, knitted Dacron graft, friction seals were created which fixed the ends of the graft to the vessel wall. This excludes the aneurysm from circulation and allows normal flow through the graft lumen. Initial treatment in five patients with serious co-morbidities is described. Each patient had an individually tailored balloon diameter and diameter and length of their Dacron graft. Standard stents were used and the diameter of the stent-graft was determined by sonography, computed tomography, and arteriography. In three of them a cephalic stent was used without a distal stent. In two other patients both ends of the Dacron tubular stent were attached to stents using a one-third stent overlap. In these latter two, once the proximal neck of the aneurysm was reached, the sheath was withdrawn and the cephalic balloon inflated with a saline/contrast solution. The catheter was gently removed caudally towards the arterial entry site in the groin to keep tension on the graft, and the second balloon inflated so as to deploy the second stent. Four of the five patients had heparin reversal at the end of the procedure. We are encouraged by this early experience, but believe that further developments and more clinical trials are needed before this technique becomes widely used.
本研究报告了动物实验和初步临床试验情况，这些实验和试验探索了在局部或区域麻醉下通过逆行股总动脉插管，放置腔内、支架锚定的涤纶人工血管来排除腹主动脉瘤的可行性。实验表明，当将球囊可扩张支架缝合到管状针织涤纶人工血管部分重叠的两端时，会形成摩擦密封，从而将人工血管的两端固定在血管壁上。这可使动脉瘤不参与血液循环，并允许血液正常通过人工血管腔。文中描述了对五名患有严重合并症患者的初始治疗情况。每位患者的涤纶人工血管的球囊直径、直径和长度均根据个体情况定制。使用标准支架，支架型人工血管的直径通过超声、计算机断层扫描和动脉造影确定其中三名患者仅使用了头端支架，未使用远端支架。另外两名患者中，涤纶管状支架的两端通过三分之一的支架重叠连接到支架上。在这两名患者中，一旦到达动脉瘤的近端颈部，就撤回鞘管，并用生理盐水/造影剂溶液对头端球囊进行充气。将导管沿尾端轻轻朝腹股沟处的动脉入口部位移除，以保持人工血管的张力，然后对第二个球囊进行充气，以便展开第二个支架。五名患者中有四名在手术结束时进行了肝素中和。我们对这一早期经验感到鼓舞，但认为在该技术广泛应用之前，还需要进一步发展和进行更多的临床试验。
