Arnaoutakis Dean J, Zammert Martin, Karthikesalingam Alan, Belkin Michael
Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Best Pract Res Clin Anaesthesiol. 2016 Sep;30(3):331-40. doi: 10.1016/j.bpa.2016.05.004. Epub 2016 Jun 30.
Endovascular repair of abdominal aortic aneurysms is an important technique in the vascular surgeon's armamentarium, which has created a seismic shift in the management of aortic pathology over the past two decades. In comparison to traditional open repair, the endovascular approach is associated with significantly improved perioperative morbidity and mortality. The early survival benefit of endovascular abdominal aortic aneurysm repair is sustained up to 3 years postoperatively, but longer-term life expectancy remains poor regardless of operative modality. Nonetheless, most abdominal aortic aneurysms are now repaired using endovascular stent grafts. The technology is not perfect as several postoperative complications, namely endoleak, stent-graft migration, and graft limb thrombosis, can develop and therefore lifelong imaging surveillance is required. In addition, a postoperative inflammatory response has been documented after endovascular repair of aortic aneurysms; the clinical significance of this finding has yet to be determined. Subsequently, the safety and applicability of endovascular stent grafts are likely to improve and expand with the introduction of newer-generation devices and with the simplification of fenestrated systems.
腹主动脉瘤的血管腔内修复是血管外科医生的重要技术手段，在过去二十年里，它给主动脉疾病的治疗带来了巨大变革。与传统开放修复相比，血管腔内修复方法能显著降低围手术期发病率和死亡率。血管腔内腹主动脉瘤修复术后早期生存获益可持续至术后3年，但无论采用何种手术方式，长期预期寿命仍不理想。尽管如此，现在大多数腹主动脉瘤都采用血管腔内支架移植物进行修复。这项技术并不完美，因为可能会出现几种术后并发症，即内漏、支架移植物移位和移植物肢体血栓形成，因此需要进行终身影像监测。此外，腹主动脉瘤血管腔内修复术后已证实存在术后炎症反应；这一发现的临床意义尚待确定。随后，随着新一代装置的推出以及开窗系统的简化，血管腔内支架移植物的安全性和适用性可能会得到改善和扩展。
