摘要
目的 总结倒喇叭支架技术（bell-bottom technique,BBT）在腹主动脉瘤合并髂总动脉瘤腔内修复手术中的应用经验.方法 回顾性分析2009年2月至2014年6月北京大学人民医院收治的17例合并髂总动脉瘤的腹主动脉瘤患者的临床资料.双侧髂总动脉瘤16例,单侧髂总动脉瘤l例.对于直径＜ 25 mm、髂内动脉无瘤样扩张、髂动脉瘤未累及髂外动脉的髂总动脉瘤采用BBT保留同侧髂内动脉.结果 17例患者均一次手术成功,技术成功率为100％.手术时间70～260 min,平均（156 ±53）min,出血量10 ～ 400 ml,平均（99±126） ml.双侧BBT 3例,单侧BBT 14例.术中发现即刻Ⅰ型内漏3例,均为主体覆膜支架近端内漏,采用大球囊扩张后2例内漏消失,1例内漏明显减少.17例患者随访时间4 ～ 68个月,中位随访时间为28个月.主动脉瘤及髂动脉瘤无直径增大或破裂,无内漏,所有BBT处理侧髂支支架通畅无血栓形成、无臀部跛行症状,所有患者无臀部、骶尾部坏死表现.结论 对于合并髂总动脉瘤的腹主动脉瘤患者,采用BBT处理髂总动脉瘤可保留同侧髂内动脉并避免相关后遗症,是一种安全有效的治疗方法.
Objective To summarize our experiences of endovascular treatment for abdominal aortic aneurysm （AAA） with common iliac artery aneurysm （CIAA） by using bell-bottom technique （BBT）.Methods From February 2009 to June 2014,endovascular aortic repair （EVAR） was performed on 17patients with AAA with CIAA using BBT,including 16 patients with bilateral and 1 patient with unilateral CIAA.Among them,patients with common iliac artery （CIA） of less than 25 mm in diameter without involvement of the internal iliac artery and external iliac artery aneurvsm were treated with BBT.Results All procedures were successfully completed.There were 3 bilateral and 14 unilateral BBT.Type Ⅰa endoleak was noticed intraoperatively in 3 cases and balloon dilation were applied,the endoleak disappeared after dilation in 2 cases and in 1 case the diminished endoleak disappeared during the follow-up period.The median follow-up of the 17 cases was 28 months （ranging,4-68 months）.During follow-up no AAA or CIAA rupture and no endoleak occurred,and no dilation of the CIAA was observed.None of them had BBT graft occlusion or buttock claudication.Conclusion AAA with CIAA can be successfully treated with EVAR and BBT,which can preserve internal iliac artery patency.
出处
《中华普通外科杂志》
CSCD
北大核心
2016年第3期189-192,共4页
Chinese Journal of General Surgery
关键词
主动脉瘤
腹
血管成形术
腔内修复
倒喇叭支架技术
Aortic aneurysm,abdominal
Angioplasty
Endovascular repair
Bell-bottom technique
