中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2013年
9期
693-695
,共3页
马晓辉%郭伟%刘小平%贾鑫%熊江%张宏鹏%张佳%杜欣%张敏宏
馬曉輝%郭偉%劉小平%賈鑫%熊江%張宏鵬%張佳%杜訢%張敏宏
마효휘%곽위%류소평%가흠%웅강%장굉붕%장가%두흔%장민굉
手术后并发症%支架%主动脉瘤,腹%髂支闭塞
手術後併髮癥%支架%主動脈瘤,腹%髂支閉塞
수술후병발증%지가%주동맥류,복%가지폐새
Postoperative complications%Stents%Aortic aneurysm,abdominal%Graft limb occlusion
目的 总结腹主动脉瘤腔内修复术(abdominal aortic aneurysm endovascular repair,EVAR)后髂支闭塞患者的病因、治疗选择,并评价治疗结果.方法 回顾性分析2008年1月至2012年12月收治的305例患者的临床资料,所有患者使用分叉支架型血管,术后6例男性患者的髂支(1.97％)在EVAR术后0～36个月发生闭塞.其中4例患者出现髂支移植物扭曲,出现扭曲的3个分支中全部发生血栓形成.临床表现为1例患者出现静息痛；4例患者出现跛行；另1例患者无症状.治疗:1例患者采用取栓+股-股旁路；1例采用髂支封堵+股-股旁路；4例患者采用取栓+支架植入.结果 6例患者手术均成功,静息痛和跛行症状消失.6例患者随访时间为6 ～18个月,平均(10±8)个月.5例患者无下肢缺血症状发生,1例患者术后半年跛行症状再次加重,行下肢动脉球囊扩张+支架植入术治疗后症状消失.结论 髂动脉扭曲可能是EVAR术后髂支闭塞的重要因素.外科旁路手术和血管腔内治疗是治疗EVAR术后发生的髂支闭塞有效和安全的方法.
目的 總結腹主動脈瘤腔內脩複術(abdominal aortic aneurysm endovascular repair,EVAR)後髂支閉塞患者的病因、治療選擇,併評價治療結果.方法 迴顧性分析2008年1月至2012年12月收治的305例患者的臨床資料,所有患者使用分扠支架型血管,術後6例男性患者的髂支(1.97％)在EVAR術後0～36箇月髮生閉塞.其中4例患者齣現髂支移植物扭麯,齣現扭麯的3箇分支中全部髮生血栓形成.臨床錶現為1例患者齣現靜息痛；4例患者齣現跛行；另1例患者無癥狀.治療:1例患者採用取栓+股-股徬路；1例採用髂支封堵+股-股徬路；4例患者採用取栓+支架植入.結果 6例患者手術均成功,靜息痛和跛行癥狀消失.6例患者隨訪時間為6 ～18箇月,平均(10±8)箇月.5例患者無下肢缺血癥狀髮生,1例患者術後半年跛行癥狀再次加重,行下肢動脈毬囊擴張+支架植入術治療後癥狀消失.結論 髂動脈扭麯可能是EVAR術後髂支閉塞的重要因素.外科徬路手術和血管腔內治療是治療EVAR術後髮生的髂支閉塞有效和安全的方法.
목적 총결복주동맥류강내수복술(abdominal aortic aneurysm endovascular repair,EVAR)후가지폐새환자적병인、치료선택,병평개치료결과.방법 회고성분석2008년1월지2012년12월수치적305례환자적림상자료,소유환자사용분차지가형혈관,술후6례남성환자적가지(1.97％)재EVAR술후0～36개월발생폐새.기중4례환자출현가지이식물뉴곡,출현뉴곡적3개분지중전부발생혈전형성.림상표현위1례환자출현정식통；4례환자출현파행；령1례환자무증상.치료:1례환자채용취전+고-고방로；1례채용가지봉도+고-고방로；4례환자채용취전+지가식입.결과 6례환자수술균성공,정식통화파행증상소실.6례환자수방시간위6 ～18개월,평균(10±8)개월.5례환자무하지결혈증상발생,1례환자술후반년파행증상재차가중,행하지동맥구낭확장+지가식입술치료후증상소실.결론 가동맥뉴곡가능시EVAR술후가지폐새적중요인소.외과방로수술화혈관강내치료시치료EVAR술후발생적가지폐새유효화안전적방법.
Objective To review our experience in the limb occlusion after abdominal aortic aneurysm endovascular repair (EVAR).Methods From January 2008 to December 2012,305 abdominal aortic aneurysm (AAA) patients were electively treated with bifurcated stent grafts.From 0 to 36 months after EVAR,iliac branches (1.97％) were found occluded 6 males,including Iliac graft distortions in 4 cases.Thrombosis occurred in three branches with distortions.Presentation included rest pain in 1 case,claudication in 4 cases,and asymptomatic in 1 case.Treatment included femoro-femoral bypass in 1 case,iliac branch plugging plus femoro-femoral bypass in 1 case,thrombectomy and stent in 4 cases.Results Operations were successful in all patients.Symptoms of rest pain and claudication cured.These 6 patients were followed-up for 6 to 18 months (10 ± 8 months).5 patients had not lower limb ischemia.Claudication in 1 patient became serious after treatment,the symptom cured after balloon dilation +stenting.Conclusions Iliac graft is one of the main causes distortion for graft limb occlusions after EVAR.Surgical bypass and endovascular treatment are efficient and safe method to treat graft limb occlusion after EVAR.
