Endurant支架治疗短瘤颈腹主动脉瘤临床疗效分析

摘要

目的 评价Endurant支架在近端瘤颈长度<10 mm的腹主动脉瘤患者中应用的安全性和有效性.方法 回顾性分析2010年1月至2015年5月复旦大学附属中山医院血管外科连续收治的22例采用Endurant主体支架治疗的近端瘤颈长度<10 mm的腹主动脉瘤患者资料.男性19例,女性3例,年龄57~84岁.所有患者术前行CT血管造影三维重建,并测量腹主动脉瘤的各项解剖参数,术中常规行标准腹主动脉瘤腔内治疗,如果有明确近端Ⅰ型内漏,再采用近端短段支架型人工血管(CUFF)或烟囱技术进行处理.观察围手术期技术成功率和临床成功率.术后定期随访,观察随访期不良事件发生率和二次干预率.结果 22例患者近端瘤颈长度5~9 mm,平均(7.2±1.4)mm;支架植入即刻造影,5例患者发生内漏.其中4例近端Ⅰ型内漏,3例近端CUFF处理、1例CUFF+左肾动脉烟囱处理.围手术期死亡1例,总体临床成功率95.4%,技术成功率为77.3%.随访6~54个月,1例(4.5%)患者发生不良事件,为迟发性近端Ⅰ型内漏,此患者术中未发现内漏,随访第6个月发生近端Ⅰ型内漏,6个月后内漏消失,未作任何处理.二次干预率为0.结论 Endurant支架在近端瘤颈<10 mm的腹主动脉瘤患者中应用是有效和安全的.%Objective To evaluate the safety and effectiveness of the Endurant stent graft for abdominal aortic aneurysm cases with proximal neck length <10 mm.Methods This study was a retrospective analysis.From January 2010 to May 2015, 22 consecutive abdominal aortic aneurysm patients with proximal neck length <10 mm were treated with endovascular aortic repair by Endurant stent graft in Department of Vascular Surgery, Zhongshan Hospital, Fudan University.There were 19 (86.3%) male cases, aging from 57 to 84 years.All patients underwent preoperative CT angiography and the anatomic parameters of abdominal aortic aneurysm were measured.All patients performed standard endovascular aortic repair first and if there was obvious proximal typeⅠ endoleak, the CUFF or the chimney technology were applied to observed the perioperative technical and the clinical success rate.During follow-up, the incidence of adverse events and the reintervention rate were observed.Results These 22 cases had proximal neck length 5 to 9 mm with the average of (7.2±1.4) mm.Immediate endoleak occurred in 5 patients with 4 cases of proximal typeⅠ endoleak, 3 cases were implanted proximal CUFF, 1 case implanted CUFF and left renal artery chimney.One case died perioperatively, the clinical success rate was 95.4%, the technical success rate was 77.3%.During the follow-up of 6 to 54 months, there was 1 case with delayed proximal type-1 endoleak, during operation the patient had no endoleak, but disappeared 6 months later without further intervention.So the incidence of adverse event was 4.5% and reintervention rate was 0.Conclusion The Endurant stent graft for abdominal aortic aneurysm cases with proximal neck length < 10 mm is safe and effective.