腹主动脉瘤覆膜支架腔内隔绝术后髂动脉瘤的开放手术修复。
Vascular suture line wrapping for Aortoiliac anastomoses following open surgical repair of Infrarenal Behçet's Aortoiliac aneurysms.
机构信息
Department of Vascular & Endovascular Surgery, Al-Hussain University Hospital, Faculty of Medicine for Males, Al-Azhar University, Darrasa, Cairo, 11675, Egypt.
Division of Vascular & Endovascular Surgery, Department of Surgery, College of Medicine, King Faisal University, Eastern Province, Al-Ahsa, 31982, Saudi Arabia.
出版信息
Orphanet J Rare Dis. 2019 Apr 15;14(1):81. doi: 10.1186/s13023-019-1048-y.
BACKGROUND
This study was conducted to evaluate our local experiences of adjunctive mechanical prosthetic wrapping for aortoiliac vascular anastomoses as a prophylactic measure following surgical repair of Behçet's aortoiliac aneurysms. The goal of prosthetic wrapping to reinforce the vascular anastomoses by mechanical protection to reduce the bleeding complications, and consequently pseudoaneurysm formation. This was aided by the administration of pre- and postoperative immunosuppressive therapy as an adjuvant treatment.
METHODS
A seven-year retrospective study was conducted between January 2006 and December 2012, retrieving data of patients with Behçet's aortoiliac aneurysms. All patients underwent open surgical repair using a heparin-bonded synthetic Dacron® graft. Data for all patients were retrieved and analyzed for diagnostic procedures, graft selection, as well as, different methods of surgical repair. Graft-related complications such as anastomotic pseudoaneurysms, occlusion, and thrombosis were also reported.
RESULTS
Sixteen patients were recruited in this study. There were 11 (69%) males and 5 (31%) females with the male to female ratio 2:1. The patients' age ranged between 25 and 47 years with the mean of 36.4 ± 7.3. All Behçet's aortic/aortoiliac aneurysms were repaired by the application of heparin-bonded Dacron® tube and bifurcated grafts. The anastomotic wrapping technique was performed for both the proximal and the distal vascular anastomoses. The technical success of aortoiliac aneurysm and wrapping techniques was achieved in 100% of patients. All patients were given pre- and postoperative systemic immunosuppressive therapy. No graft-related complications were reported except for only one anastomotic pseudoaneurysm that developed at one of the right iliac anastomoses, that developed within 24 months after follow up.
CONCLUSIONS
Mechanical prosthetic wrapping for vascular anastomoses in patients with Behçet's aortic/aortoiliac aneurysms is a feasible, simple, and reliable technique with low morbidity and mortality. It was performed as a prophylactic measure to avoid the development of postoperative anastomotic pseudoaneurysms. It must be performed for all patients with Behçet's arterial aneurysms whenever possible. Furthermore, the supplemental administration of pre- and postoperative systemic immunosuppressive therapy should be considered as an important factor for the prophylaxis and prevention of anastomotic pseudoaneurysms and other graft-related complications.
背景
本研究旨在评估我们对贝赫切特氏症腹主动脉瘤术后使用机械性人工血管包裹预防吻合口出血并发症和假性动脉瘤形成的经验。包裹人工血管可以机械性保护血管吻合口，减少出血并发症和假性动脉瘤形成。这一方法通过围手术期免疫抑制治疗作为辅助治疗。
方法
我们进行了一项回顾性研究，纳入 2006 年 1 月至 2012 年 12 月期间的贝赫切特氏症腹主动脉瘤患者。所有患者均接受肝素结合合成膨体聚四氟乙烯（Dacron®）移植物的开放手术修复。我们检索了所有患者的诊断程序、移植物选择以及不同手术修复方法的数据。还报告了与移植物相关的并发症，如吻合口假性动脉瘤、闭塞和血栓形成。
结果
本研究共纳入 16 名患者，其中男性 11 例（69%），女性 5 例（31%），男女比例为 2:1。患者年龄 25 至 47 岁，平均 36.4±7.3 岁。所有贝赫切特氏症腹主动脉瘤均采用肝素结合 Dacron®管和分叉移植物修复。近端和远端血管吻合口均采用吻合口包裹技术。100%的患者均成功完成腹主动脉瘤和包裹技术。所有患者均接受围手术期全身免疫抑制治疗。除 1 例右侧髂吻合口在随访 24 个月后发生吻合口假性动脉瘤外，无其他与移植物相关的并发症。
结论
贝赫切特氏症腹主动脉瘤患者的血管吻合口采用机械性人工血管包裹是一种可行、简单、可靠的技术，具有低发病率和死亡率。它作为一种预防措施，可避免术后吻合口假性动脉瘤的发生。对于所有贝赫切特氏症动脉动脉瘤患者，如有可能，均应进行该手术。此外，围手术期全身免疫抑制治疗的辅助应用应被视为预防吻合口假性动脉瘤和其他移植物相关并发症的重要因素。
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