CAJ | 학술논문

目的评价腔内隔绝术治疗外科高风险腹主动脉瘤(AAA)的疗效及安全性.方法 51例AAA患者行腔内隔绝术.按国际血管外科/心血管外科(SVS/ISCVS)手术风险评估方法分级,1级(较低风险)30例,2～3级(高风险)21例.根据术前CT及DSA资料合理选择支架.术后定期临床及CT影像随访,观察并发症及瘤体形态学变化.结果覆膜支架均顺利置入,技术成功率100%,术中及术后30 d无死亡.所有患者术后平均随访(29.1±20.5)个月,死亡1例(术后36 d),死因不详.主要并发症5例(9.8%),包括分支支架内血栓形成2例,股动脉切口局部并发症2例(血栓形成及淋巴管瘘),支架单臂脱位导致内漏增多1例.术后少量内漏10例(19.6%),其中5例随访期自行消失.结论腔内隔绝术治疗AAA,特别是外科高风险患者,近中期疗效满意.
목적 평개강내격절술치료외과고풍험복주동맥류(AAA)적료효급안전성.방법 51례AAA환자행강내격절술.안국제혈관외과/심혈관외과(SVS/ISCVS)수술풍험평고방법분급,1급(교저풍험)30례,2～3급(고풍험)21례.근거술전CT급DSA자료합리선택지가.술후정기림상급CT영상수방,관찰병발증급류체형태학변화.결과 복막지가균순리치입,기술성공솔100%,술중급술후30 d무사망.소유환자술후평균수방(29.1±20.5)개월,사망1례(술후36 d),사인불상.주요병발증5례(9.8%),포괄분지지가내혈전형성2례,고동맥절구국부병발증2례(혈전형성급림파관루),지가단비탈위도치내루증다1례.술후소량내루10례(19.6%),기중5례수방기자행소실.결론 강내격절술치료AAA,특별시외과고풍험환자,근중기료효만의.
Objective To evaluate the feasibility and effectiveness of endoluminal grafting for the treatment of abdominal aortic aneurysms in high-risk patients with serious co-morbidities.Methods Endoluminal stent grafting was performed in fifty-one patients(45 males and 6 females,with a mean age of 71.6±7.5 years)with abdominal aortic aneurysms.Of all the patients,21(37.7%)were high-risk surgical candidates because of associated co-morbidities.These patients were classified in grade Ⅱ and Ⅲ according to the criteria assigned by the"Society for Vascular Surgery"and"International Society for Cardiovascular Surgery".Based on the preoperative CT and DSA findings,the appropriate stent was selected for every patient.Post-operative clinical observation and CT scan were regularly carried out,the occurrence of complications and the morphological changes of the aneurysms were observed.The results were evaluated and analyzed.Results Primary technical success was achieved in all patients(100%).No death occurred during the procedure or in 30 days after the procedure.An average follow-up period of(29.1±20.5)months was made.Minor endoleak was noted on CT scans in 10 patients,and the endoleak disappeared in 5 patients during the follow-up period.One patient died from unknown cause.The total mortality rate was 2.0%(1/51).The major complications rate was 9.8%(5/51),including stent thrombosis(n=2),thrombosis at femoral artery(n=1),lymphatic fistula at femoral incision(n=1) and stent dislocation(n=1).Conclusion Endoluminal stent grafting is a safe and feasible technique for the treatment of abdominal aortic aneurysms with excellent medium-term results.This technique is especially suitable for the patients with high surgical risk.