摘要:
目的 探讨使用一体式分叉型覆膜支架腔内隔绝术治疗肾下型腹髂动脉疾病的临床经验。 方法 回顾性分析2015年8月至2019年10月昆明医科大学附属延安医院血管介入科使用一体式分叉型覆膜支架实施腔内隔绝术治疗肾下型腹髂动脉疾病87例的临床资料,评价其疗效。 结果 87例患者均成功植入一体式分叉型覆膜支架,成功率100%。术中仅置入1个一体式分叉型覆膜支架15例,接1条腿支架36例,接2条腿支架29例,接3条腿支架4例,接4条腿支架3例。因腹髂动脉角度大、扭曲,于一体式分叉型覆膜支架髂支内置入裸支架5例,远端接裸支架3例,一体式分叉型覆膜支架上方接直筒Cuff覆膜支架1例,先行髂内动脉栓塞术14例,保留双侧髂内动脉13例,保留一侧髂内动脉51例,双侧髂内动脉均封闭23例。术后均使用球囊扩张支架两端及接头。手术时间35~122 min,平均52 min;术中出血10~50 mL,平均23 mL。87例均顺利完成手术。术后1例因肾衰竭、多器官功能衰竭自动出院后死亡,其余均好转出院。术后随访85例2~24个月,均健在,失访1例。术后3~6月复查CTA:支架形态位置良好,无内漏、移位,病变封闭良好 。结论 使用一体式分叉型覆膜支架腔内隔绝术治疗肾下型腹髂动脉疾病具有微创、疗效确切、操作简便、成功率高、缩短手术时间、安全、并发症少、术后恢复快等优势,近期、中期疗效较好,远期疗效仍有待观察。
Abstract:
Objective To explore the clinical efficacy of the treatment of subrenal iliac abdominal artery disease with integrated bifurcated stent graft. Methods Retrospective analysis was performed on 87 cases of subrenal abdominal iliac artery disease treated by intracavitary isolation with unibody bifurcated stent in the Department of Vascular Interventional Surgery of Yan'an Hospital Affiliated to Kunming Medical University from August 2015 to October 2019. Results 87 patients were successfully implanted with unibody bifurcated stent, the success rate was 100%. Only one unibody bifurcated stent was implanted in 15 cases, one leg stent was inserted in 36 cases, two leg stents were inserted in 29 cases, three leg stents were inserted in 4 cases, and four leg stents were inserted in 3 cases. Due to the large angle and distorted course of the abdominal iliac artery, 5 cases were treated with a bare stent inserted into the iliac branch of the integrated bifurcated coated stent, and 3 cases were treated with a bare stent distally; One case received integrated bifurcated coated stent with straight tube CUFF coated stent above it, 14 cases underwent internal iliac artery embolization first, 13 cases retained bilateral internal iliac artery, 51 cases retained one internal iliac artery, 23 cases closed both sides of internal iliac artery. Balloon was used to expand both ends and joints of the stent after surgery. The operation time was 35 min-122 min, with an average of 52 min, blood loss during operation was 10-50 ml, with an average of 23 ml, and 87 cases successfully completed the operation. One case developed renal failure and multiple organ failure after operation, 85 cases were followed up for 2-24 months, all of them were alive, 1 case was lost. CTA was reexamined 3 to 6 months after operation: the stent was in good shape and position, without internal leakage and displacement, and the lesions were closed well. Conclusions The use of the integrated bifurcated stent graft endovascular isolation for the treatment of subrenal abdominal iliac artery disease has many advantages, such as minimal invasion, good efffect, easy operation, high success rate, short operation time, safety, less complications, quick recovery and so on. The short-term and medium-term effect is better, the long-term effect remains to be observed.