腹主动脉病变腔内修复并发症及治疗

发布时间：2018-01-09 15:22

本文关键词：腹主动脉病变腔内修复并发症及治疗　出处：《心肺血管病杂志》2016年10期 　论文类型：期刊论文

【摘要】：目的:总结腹主动脉病变腔内治疗的疗效,探讨并发症发生原因及防治措施。方法:2012年1月至2014年12月,连续性覆膜支架腔内修复术的腹主动脉病变患者224例,其中腹主动脉真性动脉瘤205例,腹主动脉假性动脉瘤5例,腹主动脉瘤破裂4例,腹主动脉穿通性溃疡4例,孤立性腹主动脉夹层2例,腹主动脉腔内修复(EVAR)术后二次介入治疗4例;男性206例,女性18例;年龄36~90岁,平均(69.0±9.2)岁。患者出院前,术后1、6、12个月及每年行主动脉CTA检查。统计不同时间段的并发症,计算其发生率及病死率。结果:术中无死亡,技术成功率100%。围手术期病死率及主要并发症率分别为0.9%(2/224)和10.3%(23/224)。围手术期主要并发症包括内漏13例、支架移位2例,瘤颈医源性夹层1例,脊髓缺血1例,入路血管损伤2例,外周血管血栓形成3例,严重低血红蛋白血症1例。随访12~48个月,随访期间病死率及并发症率分别为8.9%(20/224)和4.5%(10/224)。随访期间主要并发症包括内漏4例、间歇性跛行3例、外周血管血栓形成或闭塞2例及腹主动脉假性动脉瘤感染复发1例。结论:采用覆膜支架置入腔内修复术治疗腹主动脉瘤安全可靠,但严重并发症不客忽视。严格把握适应证、术前精确测量及术中细致操作可在一定程度上降低并发症发生。此外,应重视术后定期复查以及时发现并处理相关并发症。
[Abstract]:Objective: To evaluate the effect of endovascular treatment for abdominal aortic lesions, to explore the causes and measures of prevention and treatment of complications. Methods: from January 2012 to December 2014, the continuity of endovascular repair of abdominal aorta in 224 cases, including 205 cases of abdominal aortic aneurysm, 5 cases of abdominal aortic aneurysm, 4 cases of ruptured abdominal aortic aneurysm. 4 cases of penetrating ulcer in the abdominal aorta, 2 cases of solitary abdominal aortic dissection, endovascular repair of abdominal aorta (EVAR) after two times of interventional treatment in 4 cases; 206 cases were male, 18 females; aged 36~90 years old, the average (69 + 9.2) years old. The patients were discharged from the hospital, 1,6,12 months after operation and every year. Aortic CTA examination. Statistical different time complications, calculate the incidence and mortality rate. Results: there was no death in operation, the technical success rate of 100%. perioperative mortality and major complication rates were 0.9% (2/224) and 10.3% (23/224). The perioperative period To the complications included 13 cases of leakage, stent displacement in 2 cases, 1 cases of iatrogenic aneurysm neck dissection, 1 cases of spinal cord ischemia in 2 cases of vascular injury, peripheral vascular thrombosis in 3 cases, 1 cases of severe low hemoglobin. The follow-up of 12~48 months follow-up period, mortality rate and complication rate were 8.9% (20/224) and 4.5% (10/224). The main complications during the follow-up period, including 4 cases of leakage, 3 cases of intermittent claudication, or occlusion in 2 cases and abdominal aortic pseudoaneurysm infection recurrence in 1 cases of peripheral vascular thrombosis. Conclusion: the repair of stent placement in endovascular treatment of abdominal aortic aneurysm is safe and reliable, but no serious complications ignored. Strictly grasp the indications, preoperative accurate measurement and intraoperative careful operation can reduce the complications to a certain extent. In addition, should pay attention to the follow-up, and found the treatment related complications.

【作者单位】：首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所介入诊疗科;
【基金】：国家自然科学基金(81270388)
【分类号】：R654.3
【正文快照】： 作者单位:100029首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所介入诊疗科目前,腹主动脉腔内修复术(endovascular ab-dominal aortic repair,EVAR)已成为腹主动脉瘤首选治疗方法,具有创伤小、手术及住院时间短、术后恢复快等优点,围手术期病死率及并发症发生率显著

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