Blum U, Voshage G, Lammer J, Beyersdorf F, Töllner D, Kretschmer G, Spillner G, Polterauer P, Nagel G, Hölzenbein T
Department of Diagnostic Radiology, University Hospital, Freiburg, Germany.
N Engl J Med. 1997 Jan 2;336(1):13-20. doi: 10.1056/NEJM199701023360103.
The treatment of aortic aneurysms with endovascular stents or stent-graft prostheses is receiving increasing attention as an alternative to major abdominal surgery. To define the clinical value of this technique, we prospectively studied the use of stent-graft endoprostheses made of nitinol and covered with polyester fabric for the treatment of infrarenal abdominal aortic aneurysms.
We treated a total of 154 patients at three academic hospitals. Twenty-one patients with aortic aneurysms not involving the aortic bifurcation received straight stent-grafts, and 133 patients with aortic aneurysms involving the bifurcation and the common iliac arteries received bifurcated stent-grafts. After a unilateral surgical arteriotomy, the endoprostheses were advanced through the femoral arteries and placed under fluoroscopic guidance. Computed tomography and intraarterial angiography were performed during an average follow-up of 12.5 months.
The primary success rate, defined as complete exclusion of the abdominal aortic aneurysm from the circulation, was 86 percent in the group receiving straight grafts and 87 percent in the group receiving bifurcated grafts. In three patients the procedure had to be converted to an open surgical operation. Minor (n=13) or major (n=3) complications associated with the procedure (including 1 death) occurred in 10 percent of the patients. All patients had a postimplantation syndrome, with leukocytosis and elevated C-reactive protein levels.
Our results suggest that endovascular treatment of infrarenal abdominal aortic aneurysms is technically feasible and can effectively exclude abdominal aortic aneurysms from the circulation. With further refinement, endoluminal repair may emerge as an interventional strategy to treat infrarenal aortic aneurysms, especially in patients at high surgical risk.
作为腹部大手术的替代方法，使用血管内支架或带覆膜支架的人工血管治疗主动脉瘤正受到越来越多的关注。为了确定该技术的临床价值，我们前瞻性地研究了由镍钛合金制成并覆盖聚酯纤维织物的带覆膜支架人工血管用于治疗肾下腹主动脉瘤的情况。
我们在三家学术医院共治疗了154例患者。21例未累及主动脉分叉的主动脉瘤患者接受了直管型支架人工血管治疗，133例累及分叉和髂总动脉的主动脉瘤患者接受了分叉型支架人工血管治疗。经单侧手术动脉切开后，将人工血管经股动脉推进，并在荧光透视引导下放置。在平均12.5个月的随访期间进行了计算机断层扫描和动脉内血管造影。
以腹主动脉瘤完全从循环中排除为定义的主要成功率，在接受直管型移植的组中为86%，在接受分叉型移植的组中为87%。3例患者的手术不得不转为开放手术。10%的患者发生了与手术相关的轻微（n = 13）或严重（n = 3）并发症（包括1例死亡）。所有患者均出现植入后综合征，伴有白细胞增多和C反应蛋白水平升高。
我们的结果表明，肾下腹主动脉瘤的血管内治疗在技术上是可行的，并且可以有效地将腹主动脉瘤从循环中排除。随着进一步完善，腔内修复可能会成为治疗肾下主动脉瘤的一种介入策略，尤其是对于手术风险高的患者。
