中国血管外科杂志（电子版）
中國血管外科雜誌（電子版）
중국혈관외과잡지（전자판）
CHINESE JOURNAL OF VASCULAR SURGERY(ELECTRONIC VERSION)
2013年
4期
228-232
,共5页
腹主动脉瘤%腔内修复术%内漏%并发症
腹主動脈瘤%腔內脩複術%內漏%併髮癥
복주동맥류%강내수복술%내루%병발증
Abdominal aortic aneurysm%Endovascular aneurysm repair%Endoleak%Complication
目的：探讨腹主动脉瘤腔内修复术(EVAR)后内漏发生的原因及防治策略。方法2007年1月~2012年12月，共43例肾下型腹主动脉瘤患者接受腔内治疗。根据CT血管造影（CTA）检查及数字减影血管造影（DSA）结果选择覆膜支架植入。植入分叉型支架34例（79.1%），直管型支架6例（14.0%），主-髂单臂型支架3例（7.0%）。术后通过定期随访，了解动脉瘤大小变化及内漏发生的情况。结果术后即时造影发现内漏11例，其中Ⅰ型内漏8例（Ⅰa型5例，Ⅰb型3例），Ⅱ型1例，Ⅲ型2例。分叉型支架植入致内漏9例；直管型支架植入致Ⅰa、Ⅰb型内漏各1例。Ⅰ、Ⅲ型内漏经过一期球囊扩张、植入支架型血管或裸支架等处理，8例内漏消失。39例患者获得随访，随访时间4~50（平均18.3）个月，3例残留内漏在3个月时消失。在术后6、12个月随访时分别发现迟发性Ⅰb型、Ⅱ型内漏各2例，继续随访1~2年，未见瘤体明显增大。结论内漏的发生与动脉瘤的解剖学条件、移植物缺陷和操作技术有关；防治内漏需要把握好手术适应证、合理选择支架，并有成熟的操作经验。
目的：探討腹主動脈瘤腔內脩複術(EVAR)後內漏髮生的原因及防治策略。方法2007年1月~2012年12月，共43例腎下型腹主動脈瘤患者接受腔內治療。根據CT血管造影（CTA）檢查及數字減影血管造影（DSA）結果選擇覆膜支架植入。植入分扠型支架34例（79.1%），直管型支架6例（14.0%），主-髂單臂型支架3例（7.0%）。術後通過定期隨訪，瞭解動脈瘤大小變化及內漏髮生的情況。結果術後即時造影髮現內漏11例，其中Ⅰ型內漏8例（Ⅰa型5例，Ⅰb型3例），Ⅱ型1例，Ⅲ型2例。分扠型支架植入緻內漏9例；直管型支架植入緻Ⅰa、Ⅰb型內漏各1例。Ⅰ、Ⅲ型內漏經過一期毬囊擴張、植入支架型血管或裸支架等處理，8例內漏消失。39例患者穫得隨訪，隨訪時間4~50（平均18.3）箇月，3例殘留內漏在3箇月時消失。在術後6、12箇月隨訪時分彆髮現遲髮性Ⅰb型、Ⅱ型內漏各2例，繼續隨訪1~2年，未見瘤體明顯增大。結論內漏的髮生與動脈瘤的解剖學條件、移植物缺陷和操作技術有關；防治內漏需要把握好手術適應證、閤理選擇支架，併有成熟的操作經驗。
목적：탐토복주동맥류강내수복술(EVAR)후내루발생적원인급방치책략。방법2007년1월~2012년12월，공43례신하형복주동맥류환자접수강내치료。근거CT혈관조영（CTA）검사급수자감영혈관조영（DSA）결과선택복막지가식입。식입분차형지가34례（79.1%），직관형지가6례（14.0%），주-가단비형지가3례（7.0%）。술후통과정기수방，료해동맥류대소변화급내루발생적정황。결과술후즉시조영발현내루11례，기중Ⅰ형내루8례（Ⅰa형5례，Ⅰb형3례），Ⅱ형1례，Ⅲ형2례。분차형지가식입치내루9례；직관형지가식입치Ⅰa、Ⅰb형내루각1례。Ⅰ、Ⅲ형내루경과일기구낭확장、식입지가형혈관혹라지가등처리，8례내루소실。39례환자획득수방，수방시간4~50（평균18.3）개월，3례잔류내루재3개월시소실。재술후6、12개월수방시분별발현지발성Ⅰb형、Ⅱ형내루각2례，계속수방1~2년，미견류체명현증대。결론내루적발생여동맥류적해부학조건、이식물결함화조작기술유관；방치내루수요파악호수술괄응증、합리선택지가，병유성숙적조작경험。
Objective To investigate the causes and strategies of endoleaks after endovascular aneurysm repair (EVAR). Methods From January 2007 to December 2012, 43 patients with infrarenal abdominal aortic aneurysm were treated with endovascular repair. Stent-graft implantations were chosen by computed tomographic angiography (CTA) and digital subtraction angiography (DSA). During procedure, bifurcated stents were implanted in 34 cases (79.1%), straight tubular stents in 6 cases (14.0%) and aorto-uni-iliac stents (AUI) in 3 cases (7.0%). After operation, size of aneurysm and occurrence of endoleaks were assessed by regular follow-up. Results Endoleaks were found in 11 cases by postoperative immediate angiography, including typeⅠin 8 cases (typeⅠa in 5 cases, typeⅠb in 3 cases), typeⅡin 1 case and typeⅢin 2 cases. Among them, 9 endoleaks occurred in bifurcated stents, 1 typeⅠa and 1 typeⅠb endoleaks occurred in straight tubular stents. Eight typeⅠand typeⅢendoleaks disappeard after balloon dilatation,stent-graft or bare stent implantation. Thirty-nine cases were followed up for 4 to 50 months (average, 18.3 months). Three residual endoleaks disappeared at 3 months. Moreover, 2 late typeⅠb and 2 late typeⅡendoleaks were found at 6 months and 12 months after EVAR. The size of aneurysm did not significantly increase during the following 1 to 2 years. Conclusion The occurance of endoleaks is related to anatomic condition of aneurysm, stent defects and surgical skill. Controlling surgical indications, proper stents and skilled operation are important to prevent endoleaks.
