Heilberger P, Ritter W, Schunn C, Gabriel P, Raithel D
Klinik für Gefässchirurgie, Klinikum Nürnberg Süd.
Zentralbl Chir. 1997;122(9):762-9.
Between August 1994 and December 1996 137 patients (10 female and 127 male, mean age 66 yrs., range 27-85) with aortoiliac aneurysmal disease were treated with endovascular stent grafts. Pathology included 5 thoracic, 131 abdominal and 1 isolated iliac artery aneurysm. 88 straight tube grafts (75 Mintec, 12 EVT, 1 Chuter) and 43 bifurcated grafts (21 Mintec, 20 EVT, 2 Chuter) were implanted in the infrarenal aorta. 5 (Mintec) tube grafts were used for the thoracic aneurysms. One tapered tube graft was used to exclude the isolated iliac aneurysm. 11 patients (8%) required conversion to open surgical repair. This was due to defective devices in 5, device related occlusion of a renal artery in 2, aortic dissection in 1, occlusion of iliac outflow in 1, a large unmanageable proximal endoleak in 1 and a retroperitoneal bleeding resulting in hemorrhagic shock in 1 patient. There was one procedure related death for a mortality of 0.7%. Patients were followed every 3-6 months using CT with i.v. contrast and ultrasound duplex examinations with adjunctive usage of an intravenous ultrasound contrast agent (Levovist, Schering AG). Intraarterial DSA was used only when called for by thrombotic or stenotic complications. At a mean follow-up of 9.2 months (range 2-24 months) 16 (17%) primary and 8 (8.5%) secondary leaks (at the distal anchoring zone) were detected after implantation of tube grafts. 11 (25.6%) leaks were detected after implantation of bifurcated grafts. Iliac artery occlusion was observed in 2 patients after placement of a straight endograft, 6 times after reconstruction with a Mintec bifurcated device and 3 times after implantation of an EVT bifurcated endograft. Successful treatment of iliac artery occlusion without the need for subsequent amputation or major disability included extraanatomic bypass in 7 patients, PTA (3 patients) and implantation of wallstents (2 patients) or conservative management (1 patient).
1994年8月至1996年12月期间，137例主髂动脉瘤疾病患者（10例女性，127例男性，平均年龄66岁，范围27 - 85岁）接受了血管内支架移植物治疗。病变包括5例胸主动脉瘤、131例腹主动脉瘤和1例孤立性髂动脉瘤。88枚直管型移植物（75枚Mintec，12枚EVT，1枚Chuter）和43枚分叉型移植物（21枚Mintec，20枚EVT，2枚Chuter）植入肾下腹主动脉。5枚（Mintec）直管型移植物用于治疗胸主动脉瘤。1枚锥形直管型移植物用于隔绝孤立性髂动脉瘤。11例患者（8%）需要转为开放手术修复。原因包括5例器械缺陷、2例与器械相关的肾动脉闭塞、1例主动脉夹层、1例髂动脉流出道闭塞、1例近端大的难以处理的内漏以及1例患者因腹膜后出血导致失血性休克。有1例与手术相关的死亡，死亡率为0.7%。患者每3 - 6个月接受一次CT静脉造影检查以及超声双功检查，并辅助使用静脉超声造影剂（Levovist，先灵公司）。仅在出现血栓形成或狭窄并发症时才使用动脉内DSA。平均随访9.2个月（范围2 - 24个月），直管型移植物植入后检测到16例（17%）原发性和8例（8.5%）继发性（在远端锚定区）内漏。分叉型移植物植入后检测到11例（25.6%）内漏。植入直管型移植物后2例患者出现髂动脉闭塞，使用Mintec分叉型器械重建后出现6次，植入EVT分叉型血管内移植物后出现3次。7例患者通过解剖外旁路、3例患者通过经皮腔内血管成形术（PTA）、2例患者通过植入血管支架或1例患者通过保守治疗成功治疗了髂动脉闭塞，无需后续截肢或严重残疾。
