南方医科大学学报
南方醫科大學學報
남방의과대학학보
JOURNAL OF SOUTHERN MEDICAL UNIVERSITY
2014年
5期
747-750
,共4页
叶鹏%陈勇%曾庆乐%何晓峰%李彦豪%赵剑波
葉鵬%陳勇%曾慶樂%何曉峰%李彥豪%趙劍波
협붕%진용%증경악%하효봉%리언호%조검파
腔内修复术%完全经皮穿刺途径%血管缝合器%预缝合技术
腔內脩複術%完全經皮穿刺途徑%血管縫閤器%預縫閤技術
강내수복술%완전경피천자도경%혈관봉합기%예봉합기술
endovascular aortic repair%total percutaneous%vascular closure device%preclose technique
目的:探讨采用血管缝合器(vascular closure device, VCD)预缝合技术完全经皮穿刺途径完成主动脉腔内修复术(endovascular aortic repair, EVAR)的股动脉中长期随访结果。方法自2009年7月~2012年7月,113例主动脉瘤或夹层患者行EVAR,其中男性106例,女性7例,年龄29~85(59.4±13.5)岁。Stanford B型主动脉夹层60例,胸主动脉瘤3例,肾下型腹主动脉瘤48例,另有2例同时发现胸及腹主动脉瘤。65例胸主动脉的EVAR术分别缝合1条股动脉,50例腹主动脉的EVAR术分别缝合2条股动脉,共缝合165条股动脉。均采用VCD(Perclose ProGlide,美国Abbott)预缝合技术经皮穿刺途径完成EVAR术。术后采用CT或彩超随访股动脉,评价双侧股动脉缺血情况。结果113名患者成功完成115例次EVAR术(其中2名合并胸腹主动脉瘤患者分期共行4次EVAR术),共采用347枚VCD修复165条股动脉。使用支架输送器外径包括14 Fr 38例,16 Fr 12例,18 Fr 25例,20 Fr 24例,22 Fr 29例,24 Fr 37例。其中1条股动脉缝合失败,2条缝合后出现即时急性闭塞,1例术后1月出现右股动静脉瘘,均行外科处理痊愈,缝合成功率为97.6%(161/165)。分组统计2枚VCD缝合成功率,结果显示≤18Fr组缝合成功率明显优于≥20Fr组(分别为98.7%和81.1%,P=0.0003)。分组统计前后50%病例的2枚VCD缝合成功率,结果分别为82.9%和95.2%(P=0.013)。术后随访12~50(26±9)月未发现下肢动脉缺血症状发生,CT或彩超提示未见有明显股动脉狭窄。结论采用VCD预缝合技术完全经皮穿刺途径完成EVAR术安全可行,对于合适的病例,在度过学习曲线后可作为传统股动脉切开的备选方法。输送器外鞘外径大于或等于20Fr可能是缝合失败需转外科处理和需2枚以上VCD缝合的影响因素。
目的:探討採用血管縫閤器(vascular closure device, VCD)預縫閤技術完全經皮穿刺途徑完成主動脈腔內脩複術(endovascular aortic repair, EVAR)的股動脈中長期隨訪結果。方法自2009年7月~2012年7月,113例主動脈瘤或夾層患者行EVAR,其中男性106例,女性7例,年齡29~85(59.4±13.5)歲。Stanford B型主動脈夾層60例,胸主動脈瘤3例,腎下型腹主動脈瘤48例,另有2例同時髮現胸及腹主動脈瘤。65例胸主動脈的EVAR術分彆縫閤1條股動脈,50例腹主動脈的EVAR術分彆縫閤2條股動脈,共縫閤165條股動脈。均採用VCD(Perclose ProGlide,美國Abbott)預縫閤技術經皮穿刺途徑完成EVAR術。術後採用CT或綵超隨訪股動脈,評價雙側股動脈缺血情況。結果113名患者成功完成115例次EVAR術(其中2名閤併胸腹主動脈瘤患者分期共行4次EVAR術),共採用347枚VCD脩複165條股動脈。使用支架輸送器外徑包括14 Fr 38例,16 Fr 12例,18 Fr 25例,20 Fr 24例,22 Fr 29例,24 Fr 37例。其中1條股動脈縫閤失敗,2條縫閤後齣現即時急性閉塞,1例術後1月齣現右股動靜脈瘺,均行外科處理痊愈,縫閤成功率為97.6%(161/165)。分組統計2枚VCD縫閤成功率,結果顯示≤18Fr組縫閤成功率明顯優于≥20Fr組(分彆為98.7%和81.1%,P=0.0003)。分組統計前後50%病例的2枚VCD縫閤成功率,結果分彆為82.9%和95.2%(P=0.013)。術後隨訪12~50(26±9)月未髮現下肢動脈缺血癥狀髮生,CT或綵超提示未見有明顯股動脈狹窄。結論採用VCD預縫閤技術完全經皮穿刺途徑完成EVAR術安全可行,對于閤適的病例,在度過學習麯線後可作為傳統股動脈切開的備選方法。輸送器外鞘外徑大于或等于20Fr可能是縫閤失敗需轉外科處理和需2枚以上VCD縫閤的影響因素。
목적:탐토채용혈관봉합기(vascular closure device, VCD)예봉합기술완전경피천자도경완성주동맥강내수복술(endovascular aortic repair, EVAR)적고동맥중장기수방결과。방법자2009년7월~2012년7월,113례주동맥류혹협층환자행EVAR,기중남성106례,녀성7례,년령29~85(59.4±13.5)세。Stanford B형주동맥협층60례,흉주동맥류3례,신하형복주동맥류48례,령유2례동시발현흉급복주동맥류。65례흉주동맥적EVAR술분별봉합1조고동맥,50례복주동맥적EVAR술분별봉합2조고동맥,공봉합165조고동맥。균채용VCD(Perclose ProGlide,미국Abbott)예봉합기술경피천자도경완성EVAR술。술후채용CT혹채초수방고동맥,평개쌍측고동맥결혈정황。결과113명환자성공완성115례차EVAR술(기중2명합병흉복주동맥류환자분기공행4차EVAR술),공채용347매VCD수복165조고동맥。사용지가수송기외경포괄14 Fr 38례,16 Fr 12례,18 Fr 25례,20 Fr 24례,22 Fr 29례,24 Fr 37례。기중1조고동맥봉합실패,2조봉합후출현즉시급성폐새,1례술후1월출현우고동정맥루,균행외과처리전유,봉합성공솔위97.6%(161/165)。분조통계2매VCD봉합성공솔,결과현시≤18Fr조봉합성공솔명현우우≥20Fr조(분별위98.7%화81.1%,P=0.0003)。분조통계전후50%병례적2매VCD봉합성공솔,결과분별위82.9%화95.2%(P=0.013)。술후수방12~50(26±9)월미발현하지동맥결혈증상발생,CT혹채초제시미견유명현고동맥협착。결론채용VCD예봉합기술완전경피천자도경완성EVAR술안전가행,대우합괄적병례,재도과학습곡선후가작위전통고동맥절개적비선방법。수송기외초외경대우혹등우20Fr가능시봉합실패수전외과처리화수2매이상VCD봉합적영향인소。
Objective To evaluate the long-term outcome of the femoral artery following total percutaneous endovascular aortic repair (EVAR) with preclose technique using a vascular closure device (VCD). Methods From July, 2009 to July, 2012, total percutaneous EVAR was performed in 113 patients (106 males, 7 females;mean age 59.4±13.5 years) with pre-close technique, including 60 with Stanford type B aortic dissection, 3 with thoracic aortic aneurysm, and 48 with infra-renal abdominal aortic aneurysm, and 2 with thoracic and abdominal aortic aneurysms. The Technical success and complication rates were evaluated, and the outcomes of the femoral artery were followed up with computed tomography or color Doppler ultrasound. Results The overall technical success rate was 97.6%(161/165) with conversion to open surgery in 4 cases. The size of the sheaths used were 24Fr (n=37), 22Fr (n=29), 20Fr (n=24), 18Fr (n=25), 16Fr (n=12) and 14 Fr (n=38), and 347 VCDs were used for hemostasis of 165 femoral sites;147 femoral sites were closed using 2 VCDs. Four access-related adverse events, including femoral arterial-venous fistula, acute femoral thrombosis, bleeding, and lower extremity ischemia, occurred in 4 (2.4%) of the 165 cases. In cases using≤18Fr sheaths, the success rate of closure using 2 VCDs was 98.7%, as compared to 81.1%in cases using larger (≥20Fr) sheaths (P=0.0003). The success rate of the 82 anterior sites was lower than that of the 82 posterior sites (82.9%vs 95.2%, P=0.013). No lower extremity ischemia was observed, nor was femoral artery stenosis detected during the follow-up for 26 ± 9 months (12-50 months) in these cases. Conclusion Total percutaneous EVAR with preclose technique using VCD provides a safe and effective alternative to open femoral surgery. The sheath size can be a predictor of percutaneous access failure to require conversion to open femoral surgery or using more than 2 devices for suture. Total percutaneous endovascular aortic repair using VCD with preclose technique is safe and effective, which can be adopted as an alternative technique of surgically femoral arterial cut-down operation when the surgeon reduce the learning curve.