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[肾下腹主动脉瘤的介入血管内治疗]

[Interventional endovascular therapy of infrarenal abdominal aortic aneurysm].

作者信息

Gross-Fengels W, Daum H, Siemens P, Heuser L, Wagenhofer K U

机构信息

Abteilung für Diagnostische und Interventionelle Radiologie, Asklepios Klinik Harburg, Eißendorfer Pferdeweg 52, 21075 Hamburg, Deutschland.

出版信息

Radiologe. 2013 Jun;53(6):503-12. doi: 10.1007/s00117-012-2451-8.

Abstract

The catheter-based interventional therapy (endovascular aortic repair EVAR) of abdominal aortic aneurysms (AAA) has gained an established place in the spectrum of therapeutic options. The procedure is characterized by low peri-interventional morbidity and mortality. Multislice computed tomography (CT) has a dominant role in defining the correct indications and in selecting an appropriate stent graft prior to the intervention. The rate of acute conversions could be reduced from 2.9 % to 0 % in our own elective patient population since 2010. In our vascular centre the proportion of patients treated by EVAR was 39.5 % (102 out of 258). The procedure is used routinely in patients who have an increased risk for general anesthesia or open surgery due to concomitant diseases. It is also used in patients with a reduced local operability due to prior surgery, abdominal diseases or radiation therapy. Arterial closure devices allow a completely percutaneous approach in a certain group of patients. However, after EVAR a life-long surveillance is mandatory because delayed therapy failure has been described. In younger patients who do not have a higher risk open surgery is still an option. The paper describes techniques, results und complications of EVAR.

摘要

基于导管的腹主动脉瘤(AAA)介入治疗(血管内主动脉修复术,EVAR)在治疗选择范围内已占据一席之地。该手术的特点是围介入期发病率和死亡率较低。多层螺旋计算机断层扫描(CT)在确定正确适应症以及在介入前选择合适的支架移植物方面发挥着主导作用。自2010年以来,在我们自己的择期患者群体中,急性中转率可从2.9%降至0%。在我们的血管中心,接受EVAR治疗的患者比例为39.5%(258例中有102例)。该手术常规用于因合并疾病而全身麻醉或开放手术风险增加的患者。它也用于因既往手术、腹部疾病或放射治疗导致局部可操作性降低的患者。动脉闭合装置在特定患者群体中允许完全经皮入路。然而,EVAR术后必须进行终身监测,因为已描述有延迟治疗失败的情况。对于没有更高风险的年轻患者,开放手术仍是一种选择。本文描述了EVAR的技术、结果和并发症。

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