Please wait a minute...
J Zhejiang Univ (Med Sci)  2018, Vol. 47 Issue (6): 612-616    DOI: 10.3785/j.issn.1008-9292.2018.12.08
    
Endovascular treatment of abdominal aortic aneurysm and aortic bifurcation stenosis by unibody bifurcation stent graft
LU Kaiping(),LU Weiqing,YANG Guangwei,LAI Jifu,WU Hao,JIANG Jinsong*()
Department of Vascular Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China
Download: HTML( 0 )   PDF(1078KB)
Export: BibTeX | EndNote (RIS)      

Abstract  

Objective: To sum up experience in unibody bifurcation stent graft in the treatment of abdominal aortic aneurysm with aortic bifurcation stenosis. Methods: Clinical data of 19 cases of abdominal aortic aneurysm and aortic bifurcation stenosis received endovascular treatment using unibody bifurcation stent graft in Zhejiang Provincial People's Hospital during March 2009 and March 2018 were collected. The clinical characteristics, surgery procedure and follow-up results were reviewed. Results: Stent graft was successful in all patients, and the average operation time was (70.0±2.3) min. Leakage was found in 3 patients, in which 2 patients with type Ⅰ leakage and 1 patient with type Ⅱ leakage. All leakage disappeared 15 days after surgery. The 19 cases were followed-up for 9-48 months with the median follow-up time of 27 months, and no displacement, leakage and lower limb ischemia was observed. Conclusion: Unibody bifurcation stent graft is of satisfactory long-term effect for patients with abdominal aortic aneurysm and aortic bifurcation stenosis, and can avoid displacement of stent graft after operation.



Key wordsAortic aneurysm, abdominal/surgery      Stents      Surgical procedures, minimally invasive      Retrospective studies     
Received: 14 August 2018      Published: 15 March 2019
CLC:  R654  
Corresponding Authors: JIANG Jinsong     E-mail: lkaiping@163.com;654614713@qq.com
Cite this article:

LU Kaiping,LU Weiqing,YANG Guangwei,LAI Jifu,WU Hao,JIANG Jinsong. Endovascular treatment of abdominal aortic aneurysm and aortic bifurcation stenosis by unibody bifurcation stent graft. J Zhejiang Univ (Med Sci), 2018, 47(6): 612-616.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2018.12.08     OR     http://www.zjujournals.com/med/Y2018/V47/I6/612


一体式覆膜支架治疗分叉部狭窄腹主动脉瘤患者疗效分析

目的: 总结一体式覆膜支架在分叉部狭窄腹主动脉瘤中的临床使用特点及效果。方法: 回顾性分析2009年3月至2018年3月浙江省人民医院血管外科采用一体式覆膜支架治疗的19例腹主动脉瘤伴分叉部狭窄患者的资料、手术方法和随访结果。结果: 所有患者均支架植入成功,平均手术时间为(70.0±2.3)min,3例患者出现术中内漏(其中Ⅰ型内漏2例,Ⅱ型内漏1例),术后15 d复查消失。19例患者随访9~48个月,中位随访时间为27个月,无支架移位、远期内漏、下肢缺血。结论: 一体式支架的结构设计更适合腹主动脉瘤伴主动脉分叉部狭窄的患者,且可避免术后支架远端移位,中远期疗效较好。


关键词: 主动脉瘤, 腹/外科学,  支架,  外科手术, 微创性,  回顾性研究 
Fig 1 CT angiography of abdominal aorta in a patient
Fig 2 CT angiography and digital substraction angiography images before and after stent implantation
[1]   中华医学会外科学分会血管外科学组 . 腹主动脉瘤诊断与治疗指南[J]. 中国实用外科杂志, 2008, 28 (11): 916- 917
Vascular Surgery Group, Surgery Society, Chinese Medical Association . Guideline for diagnosis and treatment of abdominal aortic aneurysm[J]. Chinese Journal of Practical Surgery, 2008, 28 (11): 916- 917
doi: 10.3321/j.issn:1005-2208.2008.11.004
[2]   YII M K . Epidemiology of abdominal aortic aneurysm in an Asian population[J]. ANZ J Surg, 2003, 73 (6): 393- 395
doi: 10.1046/j.1445-2197.2003.t01-1-02657.x
[3]   PARODI J C , PALMAZ J C , BARONE H D . Transfemoral intraluminal graft implantation for abdominal aortic aneurysms[J]. Ann Vasc Surg, 1991, 5 (6): 491- 499
doi: 10.1007/BF02015271
[4]   LEDERLE F A , FREISCHLAG J A , KYRIAKIDEST C et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm[J]. N Engl J Med, 2012, 367 (21): 1988- 1997
doi: 10.1056/NEJMoa1207481
[5]   BYRNE J , MEHTA M , DOMINGUEZ I et al. Does Palmaz XL stent deployment for type 1 endoleak during elective or emergency endovascular aneurysm repair predict poor outcome? A multivariate analysis of 1470 patients[J]. Ann Vasc Surg, 2013, 27 (4): 401- 411
doi: 10.1016/j.avsg.2012.10.007
[6]   MOLONY D S , KAVANAGH E G , MADHAVAN P et al. A computational study of the magnitude and direction of migration forces in patient-specific abdominal aortic aneurysm stent-grafts[J]. Eur J Vasc Endovasc Surg, 2010, 40 (3): 332- 339
doi: 10.1016/j.ejvs.2010.06.001
[7]   DE BRUIN J L , BAAS A F , BUTH J et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm[J]. N Engl J Med, 2010, 362 (20): 1881- 1889
doi: 10.1056/NEJMoa0909499
[8]   OIKONOMOU K , BOTOS B , BRACALE U M et al. Proximal type Ⅰ endoleak after previous EVAR with Palmaz stents crossing the renal arteries:treatment using a fenestrated cuff[J]. J Endovasc Ther, 2012, 19 (5): 672- 676
doi: 10.1583/JEVT-12-3901R.1
[9]   AVGERINOS E D , DALAINAS I , KAKISIS J et al. Endograft accommodation on the aortic bifurcation:an overview of anatomical fixation and implications for long-term stent-graft stability[J]. J Endovasc Ther, 2011, 18 (4): 462- 470
doi: 10.1583/11-3411.1
[10]   RAITHEL D , QU L , HETZE I G . A new concept in EVAR. Anatomical fixation with the Powerlink stent-graft[J]. Endovase Today, 2006, 10:1- 2
[11]   JORDAN W D , MOORE W M , MELTON J G et al. Secure fixation following EVAR with the Powerlink XL System in wide aortic necks:results of a prospective, multicenter trial[J]. J Vasc Surg, 2009, 50 (5): 979- 986
doi: 10.1016/j.jvs.2009.05.057
[12]   HARLIN S A , BEASLEY R E , FELDMANR L et al. Endovascular abdominal aortic aneurysm repair using an anatomical fixation technique and concomitant suprarenal orientation:results of a prospective, multicenter trial[J]. Ann Vasc Surg, 2010, 24 (7): 921- 929
doi: 10.1016/j.avsg.2010.05.008
[13]   符伟国, 施德兵 . 如何做好腹主动脉瘤腔内修复术[J]. 中华外科杂志, 2007, 45 (23): 1587
FU Weiguo , SHI Debing . How to do well at endovascular repairing of abdominal aortic aneurysm[J]. Chinese Journal of Surgery, 2007, 45 (23): 1587
doi: 10.3760/j.issn:0529-5815.2007.23.002
[14]   HOWELL M H , STRICKMAN N , MORTAZAVI A et al. Preliminary results of endovascular abdominal aortic aneurysm exclusion with the AneuRx stent-graft[J]. J Am Coll Cardiol, 2001, 38 (4): 1040- 1046
doi: 10.1016/S0735-1097(01)01495-4
[1] WANG Xiaohui,HE Yangyan,WU Ziheng,ZHANG Hongkun. Efficacy of integrated minimally invasive treatment for iliac vein compression syndrome with varicose veins of lower extremities[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 577-582.
[2] YU Zuanbiao,LIN Zuodong,LANG Dehai. Long-term efficacy of percutaneous mechanical thrombectomy combined with stent implantation in treatment of acute iliofemoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 623-627.
[3] SHEN Hong,JI Feng. Efficacy and safety of digestive tract stent placement under direct visual endoscopy without X-ray monitoring in treatment of digestive tract stricture[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 643-650.
[4] XIANG Yilang,WU Ziheng,ZHANG Hongkun. Progress on in situ fenestration during thoracic endovascular aortic repair[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 617-622.
[5] YIN Xiaoliang,LANG Dehai,WANG Di. Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis[J]. J Zhejiang Univ (Med Sci), 2018, 47(6): 588-594.
[6] LOU Yelin,ZHOU Yimin,LU Hong,LYU Weiguo. Establishment of a prognostic model for preterm delivery in women after cervical conization[J]. J Zhejiang Univ (Med Sci), 2018, 47(4): 351-356.
[7] CAO Yang,FENG Yadong,JIAO Chunhua,SHI Ruihua. Segmented biodegradable esophageal stents in a porcine model: preclinical evaluation of degradation, complications and tissue reactions[J]. J Zhejiang Univ (Med Sci), 2017, 46(6): 649-655.
[8] PEI Lei, XU Jingjing, ZHANG Minming. Correlation between high signal intensity in cerebrum nucleus on unenhanced T1-weighted MR images and number of previous gadolinium-based contrast agent administration[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 487-491.
[9] LI Aijing, PAN Yuning, CHEN Bin, XIA Jianbi, GAN Fang, JIN Yinhua, ZHENG Jianjun. Association of parameters in dynamic contrast-enhanced MRI using reference region model with prognostic factors and molecular subtypes of breast cancer[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 505-510.
[10] LIU Chunmei, HUANG Pintong, WANG Yao, ZHANG Xu, YOU Xiangdong. Value of ultrasonography in diagnosis of xanthogranulomatous cholecystitis[J]. J Zhejiang Univ (Med Sci), 2017, 46(5): 552-556.
[11] ZHANG Xiaoqun, WANG Qiwen, WANG Xin, XU Xiaolei, ZHU Jianhua. Comparison of limus-eluting stent with paclitaxel-eluting stent for patients with coronary small vessel disease:a systematic review and meta-analysis[J]. J Zhejiang Univ (Med Sci), 2017, 46(3): 305-314.
[12] CHEN Gang,ZHANG Ding,YING Yacao,WANG Zhifeng,TAO Wei,ZHU Hao,ZHANG Jingfeng,PENG Zhiyi. Clinical investigation on transarterial chemoembolization with indigenous drug-eluting beads in treatment of unresectable hepatocellular carcinoma[J]. J Zhejiang Univ (Med Sci), 2017, 46(1): 44-51.
[13] WU Han,WANG Zhongjin,MING Wenjie,WANG Shuang,DING Meiping. Monitoring time of interictal epileptiform discharges by long-term video EEG in patients with epilepsy[J]. J Zhejiang Univ (Med Sci), 2017, 46(1): 30-35.
[14] XIA Guangfa, ZHU Juanying, YUAN Jun, CAO Bo, TANG Jie, CHEN Yiding. Efficacy of adjuvant endocrine therapy in breast cancer patients with a positive-to-negative switch of hormone receptor status after neoadjuvant chemotherapy[J]. J Zhejiang Univ (Med Sci), 2016, 45(6): 614-619.
[15] JIANG Qianqian, ZHULEPIYA Simayi, CHEN Yulan, ZHOU Xiaohuan, ZHANG Xiangyang, XU Xinjuan, YE Hong. Influencing factors of renal function in hypertensive patients with obstructive sleep apnea-hypopnea syndrome[J]. J Zhejiang Univ (Med Sci), 2016, 45(3): 261-267.