中国实用外科杂志

中国实用外科杂志

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利用Endurant支架行不良近端瘤颈腹主动脉瘤腔内治疗的疗效和解剖学因素分析

王永刚1，史振宇2，符伟国2   

  1. 1南京医科大学附属苏州医院介入血管科，江苏 苏州 215000；2复旦大学附属中山医院血管外科，上海 200023
  • 出版日期:2019-11-01 发布日期:2019-11-12

  • Online:2019-11-01 Published:2019-11-12

摘要：

目的    评估Endurant支架在不良近端瘤颈腹主动脉瘤病人中应用的安全性和有效性，分析影响近端瘤颈相关不良事件的解剖学因素。方法    回顾性分析2010年1月至2016年1月复旦大学附属中山医院血管外科连续收治采用Endurant支架治疗的144例近端瘤颈不良腹主动脉瘤病人资料。观察围手术期及随访过程中近段瘤颈相关不良事件，分析影响近端瘤颈相关的不良事件的近端瘤颈解剖学因素。 结果    随访时间36（1～73）个月。144例病人中，有26例病人发生不良事件，累计不良事件发生率18.1%、临床成功率98.6%、技术成功96.5%。其中发生近端瘤颈相关的不良事件19例。单因素相关分析示近端瘤颈长度、瘤颈角度、短瘤颈、扭曲瘤颈是影响Endurant支架术中及术后发生近端瘤颈相关不良事件的解剖学因素（P均＜0.05）。多因素回归分析示近端瘤颈长度、瘤颈角度、梯形瘤颈是影响Endurant支架术中及术后近端瘤颈相关不良事件的独立因素（P均＜0.05）。结论    Endurant支架治疗不良近端瘤颈腹主动脉瘤总体安全、有效，其中近端瘤颈长度、瘤颈成角和梯形瘤颈需要加强随访。

关键词: 腹主动脉瘤, 血管成形术, 支架

Abstract:

Efficacy and anatomical factors of Endurant stent graft in endovascular aortic repair of abdominal aortic aneurysm with hostile neck        WANG Yong-gang*,SHI Zhen-yu, FU Wei-guo.*Department of Intervascular Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University，Suzhou 215000，China
Corresponding author: SHI Zhen-yu, E-mail: maxshizhenyu@163.com
Abstract    Objective    To observe the safety and efficacy of Endurant stent-graft in abdominal aortic aneurysm with hostile neck, and detect the anatomic factors of hostile neck-related adverse events. Methods    The clinical data of 144 consecutive patients of abdominal aortic aneurysm with hostile proximal neck who underwent endovascular aortic repair with Endurant stentgraft from January 2010 to January 2016 in Department of Vascular Surgery, Zhongshan Hospital, Fudan University were analyzed retrospectively. The perioperative clinical and the technical success rate as well as adverse event during follow up were observed. The anatomical factors correlated with proximal neck related adverse events were analyzed. Results    The median length of follow-up was 36(1-73) months,and there were 26 cases of adverse events, with 18.1% incidence rate of adverse events. The clinical success rate was 98.6% and technical success rate 96.5%. Nineteen patients experienced proximal neck related adverse events. Univariate analysis demonstrated proximal neck length, neck angle, short neck, twist neck were anatomical factors that influenced the proximal neck related adverse events(All P＜0.05). Multifactor logistic regression analysis identified that proximal neck length,neck angle,taper neck were anatomical factors significantly correlated with proximal neck related adverse events (All P＜0.05). Conclusion    The Endurant stent graft generally presents safe and effective for the treatment of abdominal aortic aneurysm with hostile proximal neck,while patients with short,angulated and taper proximal neck warranted enhanced follow up.

Key words: abdominal aortic aneurysm, angioplasty, stent