Boyle J R, Thompson M M, Clode-Baker E G, Green J, Bolia A, Fishwick G, Bell P R
Department of Surgery, Leicester Royal Infirmary, United Kingdom.
J Endovasc Surg. 1998 Aug;5(3):216-21. doi: 10.1583/1074-6218(1998)005<0216:TAKOUA>2.0.CO;2.
To describe the management strategies used to deal with twisted aortic endografts.
Two patients with successfully excluded aortic aneurysms developed symptoms referable to previously undetected twists in their endografts (one EndoVascular Technologies [EVT] and one customized aortomonoiliac device). The limb graft occlusion in the EVT graft was treated surgically with a femorofemoral bypass, but the aortomonoiliac endograft was salvaged with percutaneous implantation of a Wallstent. During another aortomonoiliac procedure, suboptimal flow through the endograft was traced to contortion of the endograft as it passed over an angulated proximal aneurysm neck. An X-large Palmaz stent was deployed to support the graft at this point.
Unsupported aortic endografts may develop twists and kinks during deployment that can lead to low outflow and graft occlusion. Endovascular techniques are available to repair these defects postoperatively, although more precise intraoperative assessment tools may identify these problems so that they can be corrected at the initial intervention.
描述用于处理扭曲主动脉内移植物的管理策略。
两名成功排除主动脉瘤的患者出现了与之前未检测到的移植物扭曲相关的症状（1例为血管内技术公司[EVT]的移植物，1例为定制的主动脉单髂动脉装置）。EVT移植物的肢体移植物闭塞通过股-股旁路手术进行治疗，但主动脉单髂动脉内移植物通过经皮植入Wallstent得以挽救。在另一例主动脉单髂动脉手术中，发现内移植物血流欠佳是由于其在经过成角的近端动脉瘤颈部时发生扭曲。此时部署了一个超大号Palmaz支架以支撑移植物。
未加支撑的主动脉内移植物在部署过程中可能会出现扭曲和扭结，从而导致低流出量和移植物闭塞。尽管更精确的术中评估工具可能有助于识别这些问题，以便在初始干预时进行纠正，但术后仍可采用血管内技术修复这些缺陷。
