目的 探讨腔内修复术治疗复杂解剖条件肾下型腹主动脉瘤的安全性和有效性.方法 对2003年1月至2011年3月接受经股动脉植入分体式覆膜支架治疗解剖条件复杂的48例腹主动脉瘤患者的临床资料进行回顾性分析.男性37例,女性11例;年龄50～81岁,平均71.4岁.其中近端短瘤颈(＜15 mm) 14例,近端瘤颈成角大(＞60°)13例,复杂髂动脉解剖者21例,其中髂动脉严重扭曲者15例,髂动脉狭窄(直径＜7 mm)者6例.结果 所有病例治疗均获成功,术中无中转开腹手术者,围手术期生存率100％.40例患者获得随访,随访时间4-122个月,平均63个月,死亡2例,均为心脑血管意外,其余生存良好,累积生存率95.8％.Ⅰ型内漏2例,其中1例2周后消失,1例长期存在,随访过程中未发现新发内漏、支架移位或堵塞、瘤体扩大或瘤体破裂等并发症;2例封堵一侧大部分肾动脉的患者恢复良好,术后未出现肾功能不全.结论 腔内修复术治疗复杂解剖条件肾下型腹主动脉瘤安全、有效.随着经验的不断积累,腔内修复术在治疗解剖条件复杂的肾下型腹主动脉瘤中将发挥更重要的作用.%Objective To explore the safety and efficiency of endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) which have the complex aortic anatomy.Methods The clinical date of 48 AAA patients with complex aortic anatomy treated by EVAR from January 2003 to March 2011 was retrospectively analyzed.There were 37 male and 11 female patients,aged from 50 to 81 years with a mean of 71.4 years. Fourteen patients had shortaortic neck (＜15mm),13 patients had severe infrarenal angulation (＞60°),15 patients had severely tortuous iliac,6 patients had small iliac(＜8mm).The stent-grafts were deployed by both femoral arteries to treat the AAA.Result The primary technical success rate was 100％.The perioperative survival rate was 100％.Intraoperative angiograms revealed two type Ⅰ endoleaks,in which one disappeared in two weeks,another existed.Follow-up was available in 40 patients with a median of 63 months (4 to 122 months).During the follow-up period,2 patients died with no relationship to the procedures.The rest patients survived well.The accumulative survival rate was 95.8％.There were no new endoleak,stent-graft migration,aneurysm expansion,or secondary intervention during the follow-up time.Conclusions EVAR is safety and efficiency to treat the patient of infrarenal abdominal aortic aneurysm with the complex aortic anatomy.By the accumulation of experience,EVAR will play a more important role for these patients.
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