Schumacher H, Eckstein H H, Kallinowski F, Allenberg J R
Department of Surgery, Ruprecht-Karls University of Heidelberg, Germany.
J Endovasc Surg. 1997 Feb;4(1):39-44. doi: 10.1583/1074-6218(1997)004<0039:MACIAA>2.0.CO;2.
To evaluate the anatomic morphology of abdominal aortic aneurysms (AAAs) and compose a classification system to facilitate patient selection for endovascular graft (EVG) repair.
Data on 242 consecutive AAA patients evaluated on a nonemergent basis in a 3.5-year period to July 1996 were prospectively entered into a registry. Patients were examined using sequential intravenous spiral computed tomographic angiography and intraarterial digital subtraction angiography. The data collected and analyzed included: diameters of the supra- and infrarenal aorta, aneurysm, aortoiliac bifurcation, and iliac arteries; lengths of the proximal neck, distal cuff, and aneurysm; degrees of iliac artery tortuosity; and occlusion of the visceral, renal, or iliac arteries.
The 242 aneurysms could be easily grouped into three distinctive categories related to the extent of the aneurysmal disease. Type I AAAs (11.2%) had nondilated, thrombus-free infrarenal (15 mm) necks and distal (10 mm) cuffs appropriate for EVG anchoring. In type II and its subgroups (72.3%), a sufficient proximal neck was present, but the aneurysm extended into the iliac arteries; 56% of these were eligible for a bifurcated endograft. In type III (16.5%), a sufficient proximal neck was missing, independent of distal involvement. In all, 51.7% were good EVG candidates based on AAA morphology. Taking into consideration relevant concomitant vascular diseases, proximal iliac kinking, and iliac, renal, or visceral occlusive disease, only 30.2% of the population were potential candidates for an efficient and secure EVG repair using the devices currently available.
In contrast to classical open repair, detailed preoperative measurements are recommended for EVG planning. The use of liberal EVG indications may lead to a higher incidence of complications, whereas restrictive morphology-based selection criteria may offer excellent results.
评估腹主动脉瘤（AAA）的解剖形态，并构建一种分类系统，以方便为血管内移植物（EVG）修复术选择患者。
1996年7月前3.5年期间连续对242例非急诊AAA患者的数据进行前瞻性登记。患者接受了序贯静脉螺旋计算机断层血管造影和动脉内数字减影血管造影检查。收集并分析的数据包括：肾动脉上方和下方的主动脉、动脉瘤、主-髂动脉分叉处以及髂动脉的直径；近端颈部、远端袖带和动脉瘤的长度；髂动脉迂曲程度；以及内脏、肾或髂动脉的闭塞情况。
根据动脉瘤疾病的范围，242个动脉瘤可轻松分为三个不同类别。I型AAA（11.2%）具有未扩张、无血栓的肾动脉下方（15毫米）颈部和适合EVG锚定的远端（10毫米）袖带。II型及其亚组（72.3%）有足够的近端颈部，但动脉瘤延伸至髂动脉；其中56%适合使用分叉型移植物。III型（16.5%）缺少足够的近端颈部，与远端受累情况无关。总体而言，基于AAA形态，51.7%是EVG修复的良好候选者。考虑到相关的伴随血管疾病、近端髂动脉扭结以及髂动脉、肾或内脏闭塞性疾病，使用当前可用装置进行高效且安全的EVG修复时，只有30.2%的人群是潜在候选者。
与传统的开放修复不同，建议在进行EVG修复术前进行详细测量。放宽EVG适应证的使用可能会导致更高的并发症发生率，而基于形态学的严格选择标准可能会带来优异的结果。
