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目的探讨主动脉假性动脉瘤的临床特征,评价腔内隔绝术治疗主动脉假性动脉瘤的疗效及安全性。方法 2008年7月至2013年9月于沈阳军区总医院行主动脉腔内隔绝术治疗主动脉假性动脉瘤的患者16例。男13例,女3例,年龄(61.2±11.5)岁。经股动脉切开植入覆膜支架封堵主动脉假性动脉瘤破口,主动脉造影确认疗效;合并严重冠状动脉狭窄的患者,于腔内隔绝术后3~7 d完成经皮冠状动脉介入治疗(PCI)。观察主动脉疾病患者介入治疗的疗效。结果主动脉腔内隔绝术操作成功率为100%,共植入14枚主体覆膜支架及4枚短体覆膜支架,16例患者均无残余内漏。1例患者部分封闭左锁骨下动脉开口,左上肢血供无缺血症状。2例冠状动脉严重病变患者,1例行冠状动脉旁路移植术,1例行植入支架治疗。围术期无出血、心肌梗死、死亡等并发症。术后平均随访(68±29)个月,随访率为87.5%(14/16)。1例患者术后3个月发生脑出血,1例患者术后6个月发现胃癌化疗治疗病情稳定,于术后12个月发生截瘫,目前已失去行动能力。冠心病患者无心绞痛发作,无复查冠状动脉造影患者,无MACE发生。随访期间共死亡患者4例(25%),明确主动脉血管破裂死亡2例(12.5%)。结论主动脉腔内隔绝术治疗主动脉假性动脉瘤,创伤小、近期及长期疗效好,并发症低。合并冠心病患者择期二次行PCI安全可行。
Objective To investigate the clinical features of aortic pseudoaneurysm and evaluate the efficacy and safety of endovascular graft exclusion for the treatment of aortic pseudoaneurysm. Methods From July 2008 to September 2013, 16 patients with aortic pseudoaneurysm were treated by aortic endovascular exclusion in Shenyang General Hospital of PLA. There were 13 males and 3 females with a mean age of (61.2 ± 11.5) years. After the femoral artery incision and stent implantation, the aorta false aneurysm was occluded and the aorta angiography confirmed the curative effect. In patients with severe coronary artery stenosis, percutaneous transluminal coronary angioplasty was completed 3 to 7 days after endovascular exclusion Interventional therapy (PCI). To observe the effect of interventional therapy in patients with aortic diseases. Results The successful rate of aortic endovascular graft exclusion was 100%. A total of 14 main stent-grafts and 4 short-stent covered stents were implanted. No residual leakage occurred in 16 patients. One patient partially blocked the opening of the left subclavian artery, and the left upper limb blood provided no ischemic symptoms. Two patients with severe coronary artery disease, one patient undergoing coronary artery bypass grafting, and one patient underwent stent implantation. Perioperative bleeding, myocardial infarction, death and other complications. After an average follow-up of 68 ± 29 months, the follow-up rate was 87.5% (14/16). One patient developed cerebral hemorrhage 3 months after operation, and one patient was found to be stable after 6 months of operation. He had paraplegia 12 months after operation and has lost his mobility. Coronary heart disease patients without angina pectoris, no review of coronary angiography patients, no MACE. During the follow-up, 4 patients died (25%), and 2 patients died of aortic rupture (12.5%). Conclusion Aortic endovascular exclusion for the treatment of aortic pseudoaneurysms, trauma, short-term and long-term curative effect, low complication. Elective PCI in patients with coronary heart disease is feasible and safe.