Spillner G, Blum U, Langer M, Schlosser V, Beyersdorf F
Abteilung Herz- und Gefässchirurgie, Universitätsklinik Freiburg.
Zentralbl Chir. 1996;121(9):727-33.
With a series of 34 transluminal stent-graft procedures, we assessed the feasibility and clinical effectiveness of a new stent-graft for the treatment of infrarenal abdominal aortic aneurysms (AAAs). We treated 34 male patients (mean age 71 years) with straight of bifurcated nitinol stents covered with woven Dacron graft material for infrarenal excentric saccular AAA (n = 3) or AAA involving the bifurcation and the common iliac arteries (n = 31). The 18-F delivery system was advanced via a surgical arteriotomy and the stent-graft was placed under fluoroscopic control. Follow-up period ranged from 8 days to 13 months. The implantation of the stent-grafts was technically successful with exclusion of AAA in 31/34 cases (91%). In 2 patients, there was a persisting leak at the distal end of the endoprosthesis after treatment; in another, marked coiling of the external iliac artery impeded the delivery system to be advanced and consecutive rupture resulted in conversion to surgical repair. Other procedure-related complications were acute hepatic failure due to gastric bleeding in a patient with liver cirrhosis, graft occlusion due to emboli originating from the left atrium (n = 1), local hematoma (n = 1), and AV-fistula (n = 1) requiring surgery. A post-implantation syndrome with leucocytosis and elevated C-reactive protein was observed in all patients. Endoluminal repair of infrarenal AAA with use of Dacron covered nitinol stent-grafts is feasible, safe and clinically effective. However, careful long-term evaluation is necessary before it will become clinical practice.
通过一系列34例腔内支架移植物手术，我们评估了一种新型支架移植物治疗肾下腹主动脉瘤（AAA）的可行性和临床疗效。我们使用编织涤纶移植物材料覆盖的直型或分叉型镍钛诺支架治疗了34例男性患者（平均年龄71岁），用于治疗肾下偏心囊状AAA（n = 3）或累及分叉和髂总动脉的AAA（n = 31）。通过手术动脉切开术推进18F输送系统，并在荧光透视控制下放置支架移植物。随访期为8天至13个月。支架移植物的植入在技术上成功，31/34例（91%）排除了AAA。2例患者治疗后在内假体远端持续存在渗漏；另1例患者，髂外动脉明显盘绕阻碍了输送系统推进，随后破裂导致转为手术修复。其他与手术相关的并发症包括一名肝硬化患者因胃出血导致的急性肝衰竭、源于左心房的栓子导致的移植物闭塞（n = 1）、局部血肿（n = 1）以及需要手术治疗的动静脉瘘（n = 1）。所有患者均观察到植入后综合征，伴有白细胞增多和C反应蛋白升高。使用涤纶覆盖的镍钛诺支架移植物对肾下AAA进行腔内修复是可行、安全且临床有效的。然而，在其成为临床实践之前，需要进行仔细的长期评估。
