Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
Eur J Vasc Endovasc Surg. 2013 May;45(5):481-7. doi: 10.1016/j.ejvs.2013.01.038. Epub 2013 Mar 1.
We report our experience with the treatment of femoral artery aneurysms (FAAs) under local anaesthesia with limited dissection, using endografts to facilitate the proximal anastomosis and some distal anastomoses.
Between January 2006 and December 2010, six males, mean age 72 years (range, 65-80 years) with FAAs were treated at the University Hospital of Zurich. All operations were performed under local anaesthesia with analgosedation, except for one performed under spinal anaesthesia. After limited dissection and puncture of the anterior wall of the FAA, a sheath and a self-expanding endograft were introduced over a guide wire and with fluoroscopy they were guided intraluminally into the proximal normal neck of the FAA and deployed. Proximal arterial control was achieved with a balloon catheter introduced through the endograft. Then the FAAs were opened and distal arterial control is obtained with balloon catheters. The distal end of the stent graft was then sutured to the normal-sized distal arteries or to stent grafts placed within them.
Of the six FAAs, four were true and two were false anastomotic aneurysms. Mean FAA diameter was 5.0 cm (range, 3.0-6.5 cm). Four patients also had aneurysmal involvement of the external iliac artery, one patient also had deep femoral aneurysms, but deep femoral circulation was always preserved. In three of the patients, the distal anastomosis was created to the femoral artery bifurcation, in two patients to the deep femoral artery when the superficial femoral artery (SFA) was chronically occluded and in one patient to the SFA. Immediate technical success was achieved in all six patients, and graft patency was observed from 9 to 48 months (mean 29 months). There were no amputations, complications or deaths.
This technique for repair of FAAs can be performed under local anaesthesia, minimises dissection and complications and simplifies exclusion of these lesions. It is of particular value in high-risk patients with large FAAs.
我们报告了在局部麻醉下进行有限解剖，使用内置移植物辅助近端吻合和部分远端吻合治疗股动脉动脉瘤（FAA）的经验。
2006 年 1 月至 2010 年 12 月，在苏黎世大学医院治疗了 6 名男性 FAA 患者，平均年龄 72 岁（范围 65-80 岁）。除 1 例在脊髓麻醉下进行外，所有手术均在局部麻醉下进行，辅以镇痛。在 FAA 前壁进行有限解剖和穿刺后，将鞘管和自膨式内置移植物引入导丝内，并在透视下将其引导至 FAA 近端正常颈部并展开。通过内置移植物引入球囊导管以实现近端动脉控制。然后打开 FAA 并使用球囊导管获得远端动脉控制。然后将支架移植物的远端缝合到正常大小的远端动脉或置于其中的支架移植物上。
6 个 FAA 中，4 个为真性，2 个为假性吻合性动脉瘤。FAA 平均直径为 5.0 cm（范围 3.0-6.5 cm）。4 例患者还伴有髂外动脉瘤，1 例患者还伴有股深动脉瘤，但股深动脉循环始终保持。在 3 例患者中，远端吻合口创建在股动脉分叉处，在 2 例患者中，当股浅动脉（SFA）慢性闭塞时，在股深动脉处创建吻合口，在 1 例患者中，在 SFA 处创建吻合口。所有 6 例患者均立即获得技术成功，移植物通畅时间为 9 至 48 个月（平均 29 个月）。无截肢、并发症或死亡。
这种 FAA 修复技术可在局部麻醉下进行，最大限度地减少解剖和并发症，并简化这些病变的排除。对于有大 FAA 的高危患者尤其有价值。
