100 例内脏动脉动脉瘤和假性动脉瘤的血管内治疗：覆膜支架与经导管栓塞治疗比较。
Endovascular Treatment of Visceral Artery Aneurysms and Pseudoaneurysms in 100 Patients: Covered Stenting vs Transcatheter Embolization.
机构信息
1 Department of Radiology, San Raffaele Scientific Institute, Milan, Italy.
2 Department of Vascular Surgery, San Raffaele Scientific Institute, Milan, Italy.
出版信息
J Endovasc Ther. 2017 Oct;24(5):709-717. doi: 10.1177/1526602817717715. Epub 2017 Jun 29.
PURPOSE
To retrospectively report a large single-center experience of visceral artery aneurysms (VAAs) and pseudoaneurysms (VAPAs) treated with covered stenting (CS) as the first therapeutic option vs transcatheter embolization (TE).
METHODS
One hundred patients (mean age 59±14 years; 58 men) underwent 59 elective and 41 emergent endovascular procedures to treat 51 VAAs and 49 VAPAs. Seventy patients had TE and 30 received CS (27 Viabahn and 3 coronary stent grafts). Both TE and CS were performed in 10 cases.
RESULTS
Technical success was 96% (97% CS, 96% TE), and 30-day clinical success was 83% (87% CS, 81.4% TE). Four major complications occurred; 30-day mortality was 7%, mainly due to septic shock following pancreatic surgery. The midterm follow-up was 20.8 months in the total population and 32.8 months in the CS group. More than 6 months after CS all aneurysms remained excluded; stent patency was achieved in 88%. Twelve CS patients with >3 years' follow-up had maintained stent patency.
CONCLUSION
In endovascular treatment of visceral aneurysms, covered stenting was feasible in 30%. CS showed a slightly better efficacy than TE and good midterm patency. The Viabahn covered stent seems to be suitable for endovascular repair of tortuous visceral arteries affected by true or false aneurysms.
目的
回顾性报告单一中心的内脏动脉动脉瘤（VAAs）和假性动脉瘤（VAPAs）采用覆膜支架（CS）治疗的经验，CS 是作为一线治疗选择，与经导管栓塞（TE）相比。
方法
100 名患者（平均年龄 59±14 岁；58 名男性）接受了 59 例择期和 41 例紧急血管内手术，以治疗 51 例 VAAs 和 49 例 VAPAs。70 例患者接受 TE，30 例患者接受 CS（27 例 Viabahn 和 3 例冠状动脉支架移植物）。10 例患者同时进行 TE 和 CS。
结果
技术成功率为 96%（CS 为 97%，TE 为 96%），30 天临床成功率为 83%（CS 为 87%，TE 为 81.4%）。发生 4 例重大并发症；30 天死亡率为 7%，主要与胰腺手术后脓毒性休克有关。在总人群中，中位随访时间为 20.8 个月，CS 组为 32.8 个月。CS 治疗后超过 6 个月，所有动脉瘤均保持闭塞；支架通畅率达到 88%。12 例 CS 患者随访时间超过 3 年，支架保持通畅。
结论
在内脏动脉瘤的血管内治疗中，CS 的可行性为 30%。CS 的疗效略优于 TE，且中期通畅率良好。Viabahn 覆膜支架似乎适合治疗受真性或假性动脉瘤影响的迂曲内脏动脉的血管内修复。
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