Zhang Tao, Jia Xin, Liu Jie, Jia Sen-hao, Guo Wei
Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2012 Dec 18;92(47):3329-32.
To explore the option and efficacy of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) with hostile aortic proximal landing anatomy.
The clinical data of 51 AAA patients with hostile aortic proximal landing anatomy treated by EVAR from January 2010 to June 2012 at our hospital was retrospectively analyzed. There were 44 males and 7 females with a mean age of 73 years (range: 42 - 94). The anatomic measurements included a diameter of aneurysm body 32 - 100 mm, a length of proximal neck 0 - 50 mm, a width of proximal neck 15 - 40 mm and infrarenal angulation 15 - 80 degrees. In addition, there were calcification (n = 10) and thrombus lining with aortic neck (n = 15) and irregular shape of aortic neck (n = 5) respectively. The stent-grafts were deployed by 4 femoral arteries.
Many types of aortic stent were used, such as Endurant (n = 9), Talent (n = 5), Zenith (n = 31), Hercules (n = 5), Palmaz/CUFF (n = 6) and multilayer bare-stent (n = 2). And 11 patients underwent fenestrated EVAR and 31 with chimney EVAR involving renal artery (39 branches), superior mesenteric artery (3 branches) and celiac trunk (3 branches). The primary technical success rate was 100%. The perioperative endoleak rate was 17.6%. During the mean follow-up period of 13 months (2 - 28), the primary patency of stent was 96.1% and the thrombus rate of aneurysm 82.4%. Two cases of new endoleak and 3 cases of residual endoleak underwent secondary intervention. In addition, long-term follow-up was required for 3 patients with stent-graft migration (< 10 mm). There was no case of death, infection, occlusions, ischemia of lower limbs, aneurysm expansion or rupture.
A variety of EVAR options are both safe and efficacious in the treatment of AAA with hostile proximal landing zone.
探讨血管腔内修复术（EVAR）治疗腹主动脉瘤（AAA）合并主动脉近端锚定区解剖结构复杂的可行性及疗效。
回顾性分析2010年1月至2012年6月在我院接受EVAR治疗的51例AAA合并主动脉近端锚定区解剖结构复杂患者的临床资料。其中男性44例，女性7例，平均年龄73岁（范围：42 - 94岁）。解剖学测量指标包括瘤体直径32 - 100 mm，近端颈部长度0 - 50 mm，近端颈部宽度15 - 40 mm，肾下角度15 - 80度。此外，分别有10例存在钙化、15例主动脉颈部有血栓形成、5例主动脉颈部形态不规则。通过4条股动脉植入支架型人工血管。
使用了多种类型的主动脉支架，如Endurant（9例）、Talent（5例）、Zenith（31例）、Hercules（5例）、Palmaz/CUFF（6例）和多层裸支架（2例）。11例患者接受了开窗EVAR，31例接受了烟囱式EVAR，涉及肾动脉（39支）、肠系膜上动脉（3支）和腹腔干（3支）。主要技术成功率为100%。围手术期内漏率为17.6%。在平均13个月（范围：2 - 28个月）的随访期内，支架的原发性通畅率为96.1%，动脉瘤血栓形成率为82.4%。2例新发内漏和3例残余内漏患者接受了二次干预。此外，3例支架型人工血管移位（< 10 mm）患者需要进行长期随访。无死亡、感染、闭塞、下肢缺血、动脉瘤扩张或破裂病例。
多种EVAR方案治疗AAA合并近端锚定区解剖结构复杂患者安全有效。
