腹主动脉瘤腔内修复术血管入路并发症的处理

李追; 任为; 黄文; 赵渝; 成军

doi:10.16016/j.1000-5404.201801091

您当前的位置：

首页 >

文章列表页 >

腹主动脉瘤腔内修复术血管入路并发症的处理

临床医学 | 更新时间：2026-01-09

- 腹主动脉瘤腔内修复术血管入路并发症的处理
- Management of complications related to vascular access in endovascular abdominal aortic aneurysm repair: a retrospective analysis of 57 cases
- 第三军医大学学报 2018年40卷第15期页码：1407-1412
- 作者机构：
  
  400016 重庆, 重庆医科大学附属第一医院血管外科
- 作者简介：
  
  [ 成军, E-mail:cqdcj@163.com CHENG Jun, E-mail:cqdcj@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201801091
  中图分类号： R181.32;R619;R732.21
- 收稿：2018-01-11，
  
  修回：2018-03-16，
  
  纸质出版：2018-08-15
- 稿件说明：
移动端阅览
李追, 任为, 黄文, 等. 腹主动脉瘤腔内修复术血管入路并发症的处理[J]. 第三军医大学学报, 2018,40(15):1407-1412.

Zhui LI, Wei REN, Wen HUANG, et al. Management of complications related to vascular access in endovascular abdominal aortic aneurysm repair: a retrospective analysis of 57 cases[J]. Journal of Third Military Medical University, 2018, 40(15): 1407-1412.
李追, 任为, 黄文, 等. 腹主动脉瘤腔内修复术血管入路并发症的处理[J]. 第三军医大学学报, 2018,40(15):1407-1412. DOI： 10.16016/j.1000-5404.201801091.

Zhui LI, Wei REN, Wen HUANG, et al. Management of complications related to vascular access in endovascular abdominal aortic aneurysm repair: a retrospective analysis of 57 cases[J]. Journal of Third Military Medical University, 2018, 40(15): 1407-1412. DOI： 10.16016/j.1000-5404.201801091.

摘要

目的

回顾性分析腹主动脉瘤腔内修复术（endovascular aneurysm repair，EVAR）中血管入路相关早期并发症的原因及处理措施。

方法

分析我院2015年5月至2017年5月57例EVAR患者的血管入路及其并发症的处理，并发症包括髂动脉破裂、股动脉内膜损伤、血管内支架闭塞、下肢动脉血栓形成等，对不同并发症采取覆膜支架置入、人工血管移植、股-股搭桥、Fogarty导管取栓等处理措施，并于术后30 d采用超声多普勒随访术后情况。

结果

57例均完成EVAR手术，无中转开腹，其中伴有髂动脉扭曲>90° 7例，股动脉直径纤细（＜7 mm）3例，一侧髂动脉闭塞4例，合并髂动脉瘤5例（双侧髂动脉瘤2例，单侧髂动脉瘤3例）。入路血管并发症7例（12.28%），其中髂动脉破裂1例，血管内支架闭塞2例，股动脉内膜损伤3例，股髂动脉血栓形成1例。术后30 d随访，发生Ⅱ型内漏3例，1例人工血管移植后吻合口狭窄。

结论

重视术前入路血管的评估，同时掌握腔内及开放手术技巧，有助于正确认识和及时处理血管入路相关并发症，降低EVAR手术风险。

Abstract

Objective

To retrospective investigate the causes and analyze the management of early complications of vascular access in endovascular aneurysm repair (EVAR).

Methods

A total of 57 patients suffering from abdominal aortic aneurysm (AAA) and undergoing EVAR in our hospital between May 2015 and May 2017 were enrolled in this study. The complications relative to vascular access included rupture of iliac artery

injury of femoral artery intima

occlusion of stent and thrombosis of iliac-femoral artery. Stent graft placement

prosthetic vascular graft transplantation

femorofemoral artery bypass and Fogarty catheter embolectomy were performed respectively to these corresponding complications. Ultrasonography was applied for follow-up of these patients in 30 d after EVAR.

Results

EVAR procedure was completed successfully in all the cases

without conversions to open surgery. Iliac artery tortuosity

small diameter of femoral artery

unilateral occlusion of iliac artery and iliac aneurysms were present in 7

4 and 5 cases (2 unilateral and 3 bilateral iliac aneurysms)

respectively in the cohort. Complications associated with vascular access were found in 7 cases (12.28%)

including 1 case of iliac artery rupture

2 cases of stent occlusion

3 cases of intimal injury and 1 case of thrombosis in iliac-femoral artery. In 30 d after EVAR

3 cases of type Ⅱ endoleak and 1 case of anastomotic stenosis in prosthetic vascular graft transplantation occurred.

Conclusion

Careful assessment of vascular access preoperatively and excellent techniques in both endovascular and open surgery are helpful to recognize and overcome the complications relative to vascular access and to decrease the risk of EVAR.

关键词

Keywords

references

GALLITTO E, GARGIULO M, FAGGIOLI G, et al . Impact of iliac artery anatomy on the outcome of fenestrated and branched endovascular aortic repair[J ] .J Vasc Surg, 2017, 66(6):1659-1667. DOI:10.1016/j.jvs.2017.04.063.

MOULAKAKIS K G, ANTONOPOULOS C N, KLONARIS C, et al . Bilateral endograft limb occlusion after endovascular aortic repair:predictive factors of occurrence[J ] .Ann Vasc Surg, 2018, 46:299-306. DOI:10.1016/j.avsg.2017.07.019.

VALLABHANENI R, SORIAL E E, JORDAN W D JR, et al . Iliac artery recanalization of chronic occlusions to facilitate endovascular aneurysm repair[J ] .J Vasc Surg, 2012, 56(6):1549-1554. DOI:10.1016/j.jvs.2012.05.089.

LIM J H, SUNG Y W, OH S J, et al . Successful endovascular management of intraoperative graft limb occlusion and iliac artery rupture occurred during endovascular abdominal aortic aneurysm repair[J ] .Korean J Thorac Cardiovasc Surg, 2014, 47(1):71-74. DOI:10.5090/kjtcs.2014.47.1.71.

FERNANDEZ J D, CRAIG J M, GARRETT H E JR, et al . Endovascular management of iliac rupture during endovascular aneurysm repair[J ] . J Vasc Surg, 2009, 50(6):1293-1299.DOI:10.1016/j.jvs.2009.06.020.

UHLMANN M E, WALTER C, TAHER F, et al . Successful percutaneous access for endovascular aneurysm repair is significantly cheaper than femoral cutdown in a prospective randomized trial[J ] . J Vasc Surg, 2018. DOI:10.1016/j.jvs.2017.12.052.

ZENG Q L, HUANG L J, HUANG X Y, et al . Endovascular repair of abdominal aortic aneurysm with severely angulated neck and tortuous artery access:case report and literature review[J ] . BMC Surg, 2015, 15:20. DOI:10.1186/s12893-015-0005-5.

ETKIN Y, BAIG A, FOLEY P J, et al . Management of difficult access during endovascular aneurysm repair[J ] . Ann Vasc Surg, 2017, 44:77-82. DOI:10.1016/j.avsg.2017.03.190.

PAPAZOGLOU K O, SFYROERAS G S, ZAMBAS N, et al . Outcomes of endovascular aneurysm repair with selective internal iliac artery coverage without coil embolization[J ] . J Vasc Surg, 2012, 56(2):298-303. DOI:10.1016/j.jvs.2011.08.063.

NAUGHTON P A, PARK M S, KHEIRELSEID E A, et al . A comparative study of the bell-bottom technique vs hypogastric exclusion for the treatment of aneurysmal extension to the iliac bifurcation[J ] . J Vasc Surg, 2012, 55(4):956-962. DOI:10.1016/j.jvs.2011.10.121..

WANG G, ZHAI S, LI T, et al . Limb graft occlusion following endovascular aortic repair:Incidence, causes, treatment and prevention in a study cohort[J ] .Exp Ther Med, 2017, 14(2):1763-1768. DOI:10.3892/etm.2017.4658.

RONSIVALLE S, FARESIN F, FRANZ F, et al .A new management for limb graft occlusion after endovascular aneurysm repair adding a vollmar ring stripper:the unclogging technique[J ] .Ann Vasc Surg, 2013, 27(8):1216-1222. DOI:10.1016/j.avsg.2013.02.018.

VOURLIOTAKIS G, KATSARGYRIS A, TIELLIU I F, et al . A modified technique for Gore Excluder limb deployment in difficult iliac anatomy during endovascular abdominal aortic aneurysm repair[J ] .Vascular, 2015, 23(1):78-82. DOI:10.1177/1708538114529277.

TROISI N, PITOULIAS G, MICHELAGNOLI S, et al . Preliminary experience with the Endurant Ⅱ short form stent-graft system[J ] .J Cardiovasc Surg, 2017. DOI:10.23736/S0021-9509.17.09862-7.

[DEERY S E, SHEAN K E, POTHOF A B, et al . Three-year results of the endurant stent graft system post-approval study (ENGAGE PAS)[J ] . Ann Vasc Surg, 2018. [Epub ahead of print ] . DOI: 10.1016/j.avsg.2017.12.017 http://dx.doi.org/10.1016/j.avsg.2017.12.017 ..

CULVERWELL A D, KENT P, PUPPALA S. Iliac artery occlusion with "oxbow lake" formation following stent deployment in a tortuous external iliac artery during EVAR:a case report[J].Vasc Endovascular Surg, 2011, 45(7):668-671. DOI:10.1177/1538574411414922.

FRANZ R W. Unique operative approach for dealing with a tortuous external iliac artery during abdominal aortic aneurysm endografting[J].Int J Angiol, 2009, 18(1):49-51. DOI:10.1055/s-0031-1278324.

李伦, 任为.腹主动脉瘤中组织蛋白酶S以及NF-κB p65的表达及意义[J].第三军医大学学报, 2014, 36(5):483-486.

LI L, REN W. Expression and significance of cathepsin S and NF-κB p65 in abdominal aortic aneurysm[J]. J Third Mil Med Univ, 2014, 36(5):483-486.

ARKO F R, FILIS K A, SEIDEL S A, et al .How many patients with infrarenal aneurysms are candidates for endovascular repair? The Northern California experience[J ] . J Endovasc Ther, 2004, 11(1):33-40. DOI:10.1177/152660280401100104.

KANG S H, BAE J M, YUN W S. Endovascular aortic aneurysm repair using a bifurcated stent graft in a patient with femoro-femoral bypass[J].Ann Surg Treat Res, 2015, 89(2):107-110. DOI:10.4174/astr.2015.89.2.107.

HOSSAIN S, STEINMETA O K, CORRIVEAU M M, et al . Patency of the contr alateral internal iliac artery in aortouni-iliac endografting[J ] .J Vasc Surg, 2016, 63(4):974-982. DOI:10.1016/j.jvs.2015.10.056.

FUJIMURA N, HARADA H, YASHIRO H, et al . Endovascular repair of abdominal aortic aneurysm using bifurcatedstent-graft in a patient with complete occlusion from the common to the external iliac artery[J ] .Ann Vasc Surg, 2014, 28(3):740-741. DOI:10.1016/j.avsg.2013.07.007.

STRAJINA V, ODERICH G S, FATIMA J, et al . Endovascular aortic aneurysm repair in patients with narrow aortas using bifurcated stent grafts is safe and effective[J ] .J Vasc Surg, 2015, 62(5):1140-1147. DOI:10.1016/j.jvs.2015.07.050.

DORTCH J D, OLDENBURY W A, FARRES H, et al . Long-term results of aortouniiliac stent grafts for the endovascular repair of abdominal aortic aneurysms[J ] .Ann Vasc Surg, 2014, 28(5):1258-1265. DOI:10.1016/j.avsg.2013.12.026.

DURAN C, NAOUM J J, SMOLOCK C J, et al .A longitudinal view of improved management strategies and outcomes after iatrogenic iliac artery rupture during endovascular aneurysm repair[J ] .Ann Vasc Surg, 2013, 27(1):1-7.DOI:10.1016/j.avsg.2012.04.017.

JORDAN W D, NASLUND T C, ADELMAN M A, et al . Endovascular abdominal aortic aneurysm repair in patients with challenging anatomy:utility of the hybrid endograft[J ] .Vascular, 2004, 12(2):106. DOI:10.2310/6670.2004.20760.

VAN KEULEN J W, DE VRIES J P, DEKKER H, et al . One-year multicenter results of 100 abdominal aortic aneurysm patients treated with the Endurant stent graft[J ] . J Vasc Surg, 2011, 54(3):609-615. DOI:10.1016/j.jvs.2011.02.053.

RANCIC Z.Commentary on:"endograft limb occlusion in EVAR:iliac tortuosity quantified by three different indices on the basis of preoperative CTA"[J].Eur J Vasc Endovasc Surg, 2014, 48(5):534-535. DOI:10.1016/j.ejvs.2014.08.008.

FALKENSAMMER J, HAKAIM A G, ANDREW OLDENBURG W, et al . Natural history of the iliac arteries after endovascular abdominal aortic aneurysm repair and suitability of ectatic iliac arteries as a distal sealing zone[J ] .J Endovasc Ther, 2007, 14(5):619-624. DOI:10.1177/152660280701400503.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

圈套器冷切除术与热切除术在治疗结直肠小息肉安全性与有效性的回顾性对比研究

经导管主动脉瓣置换术的临床研究和应用进展

消化道异物并穿孔的危险因素分析及治疗策略

鞍上生长Rathke囊肿临床特点及神经内镜治疗效果分析

术后白蛋白下降分数对直肠癌保肛术后并发症及长期预后的预测价值