腹主动脉瘤腔内修复术联合腔内反向髂内动脉覆膜支架置入术临床观察

摘要

目的 探讨腹主动脉瘤腔内修复术联合反向髂内动脉覆膜支架置入术治疗腹主动脉瘤的疗效.方法 自2013年4-6月,于北京安贞医院行腹主动脉瘤腔内修复术联合反向髂内动脉覆膜支架置入术的患者共3例,均为男性,年龄分别为57、66、65岁,采用双侧切开暴露股动脉,对侧送导丝置入转流侧髂内动脉内保留,依次送入腹主动脉支架主体、髂分支及转流支架并分别完全释放.结果 腹主动脉支架选择ENDURANT(Medtronic,美国)或EXCLUDER(GORE,美国)的2例患者转流支架内可见造影剂充盈,转流侧髂内动脉及其分支显影良好,另1例腹主动脉支架选择Zenith(COOK,美国)的患者自转流支架开口处闭塞.术后1个月CT血管造影显示所有患者未出现支架内漏和支架移位等并发症.结论 对于腹主动脉瘤累及双侧髂动脉需行腔内修复术并覆盖双侧髂内动脉患者,同时并行反向髂内动脉腔内覆膜支架置入术能够保护单侧髂内动脉,但还需进一步扩大病例数以分析影响转流支架通畅的因素,并进行长期随访观察远期疗效.%Objective To investigate the curative effect of reverse crossover chimney technique combined with endovascular aneurysm repair treating abdominal aortic aneurysm.Methods Three cases (3 males,average age:57,66,65 years old) received endovascular aneurysm repair(EVAR) and reversed crossover chimney technique in abdominal aortic aneurysm.The vascular stent was sent from contralateral femoral artery.After intervention,digital subtraction angiography showed that abdominal aortic aneurysm was repaired ; bypass-stent and ipsilateral inner iliac artery were unobstructed.Results Contrast medium was fully filled in abdominal aorta and the abdominal aorta was well displayed in 2 cases using bypass-stent,ENDURANT (Medtronic,USA) or EXCLUDER (GORE,USA).The ipsilateral inner iliac artery was also well displayed.Abdominal aorta was obstructed in the opening of the iliac artery in one case with Zenith(COOK,USA) stents.One month later,computed tomography angiography(CTA) showed that there were no endoleaks or displacement in all three cases.Conclusion For patients with abdominal aortic aneurysm,if bilateral inner iliac arteries are involved,reverse crossover chimney technique after EVAR can protect unilateral inner iliac artery from being obstructed.