Grenon S Marlene, Gagnon Joel, Hsiang York N, Chen Jerry C
Division of Vascular Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC.
Can J Surg. 2009 Oct;52(5):E156-60.
To decrease the morbidity associated with cut-downs during endovascular aneurysm repair, some authors have suggested the totally percutaneous endovascular repair (PEVAR). The goal of this report is to evaluate and describe our centre's experience with the total percutaneous endovascular aneurysm repair (PEVAR) for aortic abdominal aneurysm (AAA).
We performed a retrospective analysis of 15 consecutive patients with AAA, including 1 with right common iliac artery aneurysm.
There were 12 men and 3 women with a mean age of 74 (standard deviation [SD] 2) years who underwent PEVAR with a Perclose ProGlide suture-mediated closure system between July 2007 and July 2008. All surgeries were elective. Forty percent of patients had a history of smoking, 73% were hypertensive, 33% were diabetic, 20% had chronic obstructive pulmonary disease and 40% had coronary artery disease. Fourteen patients had bilateral deployment for bifurcated devices (7 bifurcated Gore Excluder, 7 bifurcated Cook Zenith grafts), and 1 patient had unilateral deployment for a Cook Zenith device. The outer diameter of the sheaths used for puncture sites was on average 18.1-Fr (SD 0.6), with main bodies being 21.1-Fr (SD 0.3) and contralateral sides 15-Fr (SD 0.3). Procedural success was 93%, with 1 patient requiring a femoral artery cut-down because of failure of the Perclose device to deploy in the groin. Another patient had persistent venous bleeding in 1 puncture site that stopped with skin suturing. Endovascular aneurysm repair was 100% with no conversion to open surgery and no type-I endoleaks. The mean length of stay in hospital was 2.2 (SD 0.4) days. There were no long-term groin complications at 6 (SD 1) months' follow-up.
To our knowledge, this is the first Canadian report of experience with PEVAR using the Perclose device. The technique is safe, reliable and allows discharge of patients soon after surgery.
为降低血管内动脉瘤修复术中切开相关的发病率，一些作者提出了完全经皮血管内修复术（PEVAR）。本报告的目的是评估并描述我们中心采用完全经皮血管内修复术（PEVAR）治疗腹主动脉瘤（AAA）的经验。
我们对15例连续的腹主动脉瘤患者进行了回顾性分析，其中1例合并右髂总动脉瘤。
2007年7月至2008年7月期间，12例男性和3例女性平均年龄74（标准差[SD]2）岁的患者接受了使用Perclose ProGlide缝线介导闭合系统的PEVAR手术。所有手术均为择期手术。40%的患者有吸烟史，73%的患者患有高血压，33%的患者患有糖尿病，20%的患者患有慢性阻塞性肺疾病，40%的患者患有冠状动脉疾病。14例患者采用双侧植入分叉型器械（7例为分叉型戈尔覆膜支架，7例为分叉型库克天顶移植物），1例患者采用单侧植入库克天顶器械。穿刺部位使用的鞘管外径平均为18.1F（标准差为0.6），主体为21.1F（标准差为0.3），对侧为15F（标准差为0.3）。手术成功率为93%，1例患者因Perclose器械在腹股沟区植入失败而需要切开股动脉。另1例患者1个穿刺部位持续静脉出血，经皮肤缝合后停止。血管内动脉瘤修复成功率为100%，无转为开放手术的情况，也无I型内漏。平均住院时间为2.2（标准差为0.4）天。在6（标准差为1）个月的随访中，无长期腹股沟并发症。
据我们所知，这是加拿大第一份关于使用Perclose器械进行PEVAR的经验报告。该技术安全、可靠，术后患者可很快出院。
