CAJ | 학술논문

目的探讨肾下腹主动脉瘤腔内修复术中不良近端锚定区(hostile neck anatomy,HNA)对Ⅰ a型内漏的影响.方法 2008年7月至2011年7月对195例非破裂肾下腹主动脉瘤患者行腔内修复术治疗.其中男150例,女45例.年龄52～95岁,平均(69.0±2.5)岁.43例为HNA(22.1％).所有患者术前均进行CT血管重建检查,获得瘤颈的相关资料,统计分析HNA与Ⅰ a型内漏的关系.术后3、6、12个月及每年进行随访.结果 195例术中23例出现Ⅰa型内漏,采用反复球囊扩张、延长型支架、Palmaz支架及烟囱技术进行治疗,仅1例术后仍残留少量内漏.技术成功率为98.5％ 192/195).其中瘤颈成角与Ⅰ a型内漏的发生明确相关.平均随访时间(18±3)个月,1年生存率为97.4％ (190/195),3年生存率为89.2％ (174/195).结论近端锚定区成角与Ⅰ a型内漏相关,术中I a型内漏修复成功率高,中远期结果满意.
목적 탐토신하복주동맥류강내수복술중불량근단묘정구(hostile neck anatomy,HNA)대Ⅰ a형내루적영향.방법 2008년7월지2011년7월대195례비파렬신하복주동맥류환자행강내수복술치료.기중남150례,녀45례.년령52～95세,평균(69.0±2.5)세.43례위HNA(22.1％).소유환자술전균진행CT혈관중건검사,획득류경적상관자료,통계분석HNA여Ⅰ a형내루적관계.술후3、6、12개월급매년진행수방.결과 195례술중23례출현Ⅰa형내루,채용반복구낭확장、연장형지가、Palmaz지가급연창기술진행치료,부1례술후잉잔류소량내루.기술성공솔위98.5％ 192/195).기중류경성각여Ⅰ a형내루적발생명학상관.평균수방시간(18±3)개월,1년생존솔위97.4％ (190/195),3년생존솔위89.2％ (174/195).결론 근단묘정구성각여Ⅰ a형내루상관,술중I a형내루수복성공솔고,중원기결과만의.
Objective To determine the influence of hostile neck anatomy on type Ⅰ a endoleak development after endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysmal disease.Methods From July 2008 to July 2011,195 consecutive patients with non-ruptured abdominal aortic aneurysms (AAA) were treated with EVAR.There were 150 males and 45 females,aging from 52 to 95 years with a mean of 69 years.Forty-three patients were with hostile neck anatomy ( HNA ).High-resolution computed tomography was abtained in all patients,with detailed measurement of proximal neck parameters.Univariate and multivariate analyses were used to compare Ⅰ a endoleak and HNA.Follow-up protocol consisted of computed tomography (CT) angiograms or ultrasound at 3,6,and 12 months,and annually thereafter.Results Twenty-three patients had intraoperative type Ⅰ a endoleaks.The adjunctive measures,such as repeated balloon angioplasty,cuff extension,Palmaz stent placement and chimney technique were used for treating type Ⅰ a endoleak.Small endoleak remained in only one patient.The technical success rate was 98.5％ (192/195).The association between type Ⅰ a endoleak development and magnitude of the infrarenal angle was statistically significant.The mean follow-up time was ( 18 ± 3 )months.The survival rates at 1- and 3-year were 97.4％ and 89.2％ respectively.Conclusions The proximal neck angle is related to intraoperative type Ⅰ a endoleak occurrence,but other factors often thought to be indicative of adverse neck anatomy are not significant predictors.Most type Ⅰ a endoleaks in this study were uccessfully eliminated intraoperatively with a satisfactory mid to long term results.