May J, White G H, Yu W, Waugh R C, Stephen M S, Harris J P
Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
Ann Vasc Surg. 1996 May;10(3):254-61. doi: 10.1007/BF02001891.
The aim of this prospective study was to analyze the outcome of elective endoluminal grafting in patients with various morphologies of abdominal aortic aneurysms (AAA). Between May 1992 and May 1994, endoluminal repair of AAA was undertaken in 40 patients. After detailed imaging by means of CT scanning and arteriography, aneurysms were classified into one of two types according to the following criteria: type I (suitable for transfemoral implantation of a straight tube graft), AAA with a proximal neck (2 cm or longer), a distal neck (1.5 cm or longer), and an iliac artery diameter of 8 mm or greater (N = 19); or type II (requiring tapered aortoiliac or bifurcated grafts or access through an iliac approach), AAA that did not fit the type I criteria (N = 21). Radiographic guidance was used to pass the aortic endografts (38 Dacron and 2 PTFE) via a delivery sheath introduced through the femoral or iliac arteries into the aorta. The configuration of the aortic endografts was tubular in 26 patients, tapered aortoiliac in 11, and bifurcated in three. Successful endoluminal repair was achieved in 17 (89%) of 19 patients with type I AAA and in 15 (71%) of 21 patients with type II AAA. All failed endoluminal repairs proceeded to successful open repair, and there were no deaths during the period of hospitalization for the operation. The mean operative time and mean hospital stay were shorter in patients with type I AAA compared to patients with type II AAA. The incidence of postoperative complications was 37% in type I endoluminal repairs compared to 71% in type II endoluminal repairs. There was one cardiac death (procedure related) within 30 days, and there were three late deaths (one cardiac, one from liver failure in a type II AAA repair, and one from a ruptured esophagus in a type I repair). These preliminary results suggest that there is a better outcome in transfemoral endoluminal tube graft repair of aneurysms conforming to type I criteria compared to endoluminal repair of the more complex type II AAA.
这项前瞻性研究的目的是分析不同形态腹主动脉瘤（AAA）患者择期腔内移植的结果。1992年5月至1994年5月，对40例患者进行了AAA腔内修复。通过CT扫描和动脉造影进行详细成像后，根据以下标准将动脉瘤分为两种类型之一：I型（适合经股动脉植入直管移植物），近端颈部（2 cm或更长）、远端颈部（1.5 cm或更长）且髂动脉直径8 mm或更大的AAA（N = 19）；或II型（需要锥形主动脉髂动脉或分叉移植物或经髂动脉途径进入），不符合I型标准的AAA（N = 21）。在影像学引导下，通过经股动脉或髂动脉插入的输送鞘将主动脉内移植物（38个涤纶和2个聚四氟乙烯）送入主动脉。26例患者的主动脉内移植物为管状，11例为锥形主动脉髂动脉，3例为分叉形。19例I型AAA患者中有17例（89%）成功进行了腔内修复，21例II型AAA患者中有15例（71%）成功进行了腔内修复。所有腔内修复失败的患者均成功进行了开放修复，手术住院期间无死亡病例。与II型AAA患者相比，I型AAA患者的平均手术时间和平均住院时间更短。I型腔内修复术后并发症发生率为37%，II型腔内修复术后并发症发生率为71%。30天内有1例心脏死亡（与手术相关），3例晚期死亡（1例心脏死亡，1例II型AAA修复术后死于肝功能衰竭，1例I型修复术后死于食管破裂）。这些初步结果表明，与更复杂的II型AAA腔内修复相比，符合I型标准的动脉瘤经股动脉腔内管形移植物修复的效果更好。
