摘要
目的评价开窗/分支支架技术在腹主动脉扩张性疾病患者内脏动脉分支重建中的应用价值。方法本研究为回顾性队列研究。回顾性分析2022年5月至2024年1月安徽医科大学第二附属医院血管外科10例医师自制支架应用开窗/分支支架技术重建内脏动脉分支的腹主动脉扩张性疾病患者的临床资料。10例患者中, 夹层术后腹主动脉瘤样扩张6例, 胸腹主动脉瘤Ⅳ型4例。根据术前影像学资料, 行单主干腔内治疗和双主干腔内治疗。收集患者的相关临床资料(基线资料、术前解剖参数、围术期指标、随访结局指标), 分析整体治疗效果。结果 10例患者均成功完成内脏动脉分支的重建, 技术成功率为100%。根据开窗数量分为三开窗组(5例)和四开窗组(5例)。采用单主干技术8例, 双主干技术2例。共重建内脏动脉37条, 包括腹腔干7条, 肠系膜上动脉10条, 左右肾动脉各10条。共植入支架62枚, 每位患者植入支架(6.20±1.14)枚。术中出血量为(128.00±64.60)ml, 术后重症监护时间为(16.58±7.68)h, 三开窗组出血量和监护时间均低于四开窗组, 但差异均无统计学意义(均P>0.05)。围术期出现肝功能不全2例, 移植物综合征3例, 经保守治疗后均好转。10例患者均获得随访, 随访时间为(13.10±3.46)个月。1例因内漏引起瘤体进展给予再干预治疗。结论开窗/分支支架技术重建内脏动脉为腹主动脉扩张性疾病患者实施全腔内治疗提供选择。
Objective To evaluate the application of the fenestration/branched stent graft technique in the reconstruction of visceral artery branches in patients with abdominal aortic dilatation diseases.Methods In this retrospective cohort study,clinical data was collected from 10 patients whose diseases had been treated with physician-made stents for visceral artery branches reconstruction using the fenestrated/branched stent draft technique at the Department of Vascular Surgery,Second Hospital of Anhui Medical University from May 2022 to January 2024.Among the 10 patients,6 had postoperative aneurysmal dilation of the abdominal aorta,and 4 were diagnosed with type Ⅳ thoracoabdominal aortic aneurysms.Based on preoperative imaging,a single main trunk endovascular treatment or double main trunk endovascular treatment was performed.Collected clinical data included baseline information,preoperative anatomical parameters,perioperative indicators and follow-up outcomes,and the overall treatment effectiveness was analyzed.Results All 10 patients successfully underwent reconstruction of visceral artery branches,with a technical success rate of 100%.Based on the number of fenestrations,patients were categorized into groups with three fenestrations(5 cases)and four fenestrations(5 cases).Eight cases were treated using a single main trunk technique,and two using a double main trunk technique.A total of 37 visceral arteries were reconstructed,including 7 celiac trunks,10 superior mesenteric arteries,and 10 arteries for both the left and right kidneys respectively.A total of 62 stents were implanted,with(6.20±1.14)stents per patient.Intraoperative blood loss was(128.00±64.60)ml,and postoperative intensive care unit stay was(16.58±7.68)hours,which was lower in the three-fenestration group compared to the four-fenestration group without significant difference(both P>0.05).During the perioperative period,2 cases experienced hepatic dysfunction and 3 cases experienced allograft syndrome,all of which improved with conservative treatment.All 10 patients were followed up for a duration of(13.10±3.46)months.One case required re-intervention due to aneurysm progression caused by endoleak.Conclusion The fenestrated/branched stent graft technique for reconstructing visceral arteries provides an option for comprehensive intracavitary treatment for patients with abdominal aortic dilatation disease.
作者
郑启铜
叶琨
陶然
王文斌
孔令尚
Zheng Qitong;Ye Kun;Tao Ran;Wang Wenbin;Kong Lingshang(Department of Vascular Surgery,The Second Hospital of Anhui Medical University,Hefei 230071,China)
出处
《中华血管外科杂志》
2024年第3期166-171,共6页
Chinese Journal of Vascular Surgery
关键词
腹主动脉疾病
体外开窗
分支支架技术
腔内修复术
Abdominal aortic disease
Physician-modified fenestration
Branched stent graft technique
Endovascular repair
