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中华血管外科杂志
中华血管外科杂志

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中华血管外科杂志/Journal Chinese Journal of Vascular Surgery
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    慢性肢体威胁性缺血的血运重建策略及其临床争议性问题

    刘昌伟汪鹏王丽萍
    237-241页
    查看更多>>摘要：慢性肢体威胁性缺血（CLTI）的发病率随着人口老龄化的加剧逐年升高，患者的生活质量和预期寿命也受到严重影响。有效的血运重建是CLTI患者缓解症状和恢复创面的重要治疗手段，但病变血管的术后管腔再狭窄率仍较高，且再次手术的疗效也不尽如人意。因此，CLTI的首次治疗策略对其预后尤为重要，但目前对于CLTI的治疗策略仍有争议，尤其是在干预时机、干预策略以及干预手段等方面。本文就目前CLTI的血运重建策略及其临床争议性问题进行简要阐述。 The prevalence of chronic limb-threatening ischemia (CLTI) is increasing year by year with the aging population, and the life quality and life expectancy of patients are severely affected. Effective revascularization is an essential treatment for symptomatic relief and ulcer healing in patients with CLTI, but the rate of restenosis in diseased vessels remains high as well as the efficacy of reoperation is not as good as it should be. Therefore, the strategy of the first treatment for CLTI is particularly important for its prognosis.However,the treatment for CLTI is still controversial, especially in terms of the timing of intervention, strategy of intervention, and means of intervention. This article briefly describes the current strategies of revascularization in chronic limb-threatening ischemia and its clinical controversies.

    慢性肢体威胁性缺血血管腔内重建动脉旁路手术

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    如何提高下肢动脉粥样硬化闭塞症腔内治疗术后的通畅率？

    谷涌泉王辉王丽萍
    242-245页
    查看更多>>摘要：下肢动脉粥样硬化闭塞症发病率及致残率逐年增加，严重危害患者的生活质量并给社会经济发展带来重大负担。腔内技术创伤小及恢复快等优势使其逐渐成为下肢动脉粥样硬化闭塞症的首选治疗方式，但腔内治疗术后仍存在再狭窄及靶病变再干预率较高等问题。本文就如何利用现存腔内技术围绕围术期准备及血管准备等方面进行简要概述，从而达到有效提高靶病变血管远期通畅率的目的。 The incidence and disability rate of lower extremity atherosclerotic obliterans are increasing year by year, which seriously jeopardizes the quality of life of patients and imposes a significant burden on the socio-economic development. The advantages of endovascular treatments, such as less trauma and faster recovery have rendered endovascular treatments the first choice for lower extremity atherosclerotic obliterans. However, there are still problems such as restenosis and a high rate of target lesion reintervention after endovascular treatments. This article briefly introduces how to use the existing endovascular treatments in perioperative preparation and intraoperative blood vessel preparation, so as to effectively improve the long-term patency rate of target lesion vessels.

    动脉粥样硬化闭塞症下肢血管腔内技术围手术期准备血管准备

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    如何正确理解“leave the right thing behind”理念？

    包俊敏王丽萍
    246-252页
    查看更多>>摘要：要提高下肢动脉硬化闭塞症腔内治疗的疗效，首先要正确评估和区分下肢动脉闭塞的病变性质，选择恰当的血管准备方式并对其结果做出正确评估，在此基础上才能决定到底是选择药物涂层球囊还是植入支架，而要植入支架应先了解每一款支架的性能特性，根据病变性质选择最合适的支架。这就是“ leave the right thing behind”理念。 To improve the efficacy of endovascular treatment of arteriosclerosis obliterans of the lower extremities, it is first necessary to correctly evaluate and distinguish the nature of the lesion, select the appropriate vascular preparation method and make a correct evaluation of its results. On this basis, it can be decided whether to use a drug-coated balloon or implant a stent. If the latter option is chosen, it is necessary to understand the performance and characteristics of each stent and select the most suitable one according to the nature of the lesion. This follows the idea of "leave the right thing behind".

    动脉硬化闭塞症下肢腔内治疗评估血管准备支架植入

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    下肢动脉硬化闭塞症腔内治疗热点话题

    叶志东张建彬王丽萍
    253-256页
    查看更多>>摘要：下肢动脉硬化闭塞症（ASO）的腔内治疗蓬勃发展，目前已成为首选的治疗方案。随着器械和技术的进步，腔内治疗的适应证逐渐拓展，效果逐渐改善。本文对下肢ASO腔内治疗的部分热点话题做一探讨。 The endovascular treatment of lower extremity arteriosclerosis obliterans (ASO) has flourished and become the preferred treatment option. With the advancement of devices and technology, this kind of treatment is applied in expanded indications with improving effectiveness. This article introduces some hot topics in the endovascular treatment of lower extremity ASO.

    下肢动脉硬化闭塞症腔内治疗动脉粥样硬化

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    下肢静脉疾病压力治疗

    王劲松陈贵宇王丽萍
    257-260页
    查看更多>>摘要：压力治疗是下肢静脉疾病治疗方案的一个重要组成部分，能有效缓解患肢不适，延缓病情进展，在临床中被广泛应用。压力治疗产品选择较多，从而导致不同的临床效果。全面了解压力治疗方法的相关知识和临床运用，对于提高患者依从性和临床效果具有重要意义。因此，本文就下肢静脉疾病的压力治疗机制、禁忌证、依从性以及临床运用方面作一介绍。 Compression therapy plays a crucial role in the treatment of lower extremity venous diseases. It can effectively alleviate the discomfort of the affected limb and delay the progression of the disease, making it widely applied in clinical practice.Given the diversity of available compression therapy products,clinical outcomes can vary significantly. A comprehensive understanding of the relevant knowledge and clinical application of compression therapy is of great significance for improving patient compliance and clinical effectiveness. Therefore, this article mainly introduces the mechanism, contraindications, compliance and clinical application of compression therapy in lower extremity venous diseases.

    慢性下肢静脉疾病压力治疗适应证

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    腔内治疗TASC-ⅡD级主髂动脉闭塞症的中远期临床疗效

    李佳亮张永保房杰施焘...
    261-266页
    查看更多>>摘要：目的 探讨腔内治疗复杂主髂动脉闭塞症（AIOD）的临床疗效。 方法 回顾性分析2016年1月至2022年10月北京阜外医院血管外科采用腔内治疗的71例泛大西洋外周动脉疾病诊疗多学会专家共识第二版（TASC-Ⅱ）分级为D级的AIOD患者的临床资料。其中男性66例，女性5例，年龄（64.4±8.9）岁（范围：39~88岁）。观察腔内治疗的手术疗效及随访结果。通过单因素及多因素Logistic回归分析影响术后血管通畅率的危险因素，采用Kaplan-Meier曲线比较分析重度钙化和非重度钙化组患者生存率情况。 结果 χ 71例患者中，60例患者行一期支架植入，11例行置管溶栓后二期支架植入，技术成功率为100%（71/71）。包括“对吻”覆膜支架51例，单纯裸支架7例，髂动脉支架+股动脉膜剥脱2例，覆膜支架+裸支架11例。患者术后踝肱指数（0.92±0.21）较术前（0.53±0.26）提高，差异有统计学意义（t=27.305，P<0.01）。术后发生急性支架内血栓形成2例，穿刺部位血肿3例，髂外动脉破裂1例。65例患者获得随访，随访时间为（42.5±21.8）个月（范围：6~82个月），随访期内12例出现支架内再狭窄，1例于术后1个月行膝上截肢术。一期通畅率为81.5%（53/65），二期通畅率为100%（3/3），保肢率为98.5%（64/65）。多因素Logistic回归分析显示，重度钙化病变是影响患者术后通畅率的独立影响因素（OR=9.56，95%CI：1.76~51.77，P=0.01）。Kaplan-Meier生存曲线显示，重度钙化患者的通畅率较非重度钙化患者低，差异有统计学意义（Log-rank 2=10.038，P=0.01）。 结论 腔内治疗复杂AIOD具有较好的中远期通畅率。重度钙化病变是影响术后靶血管通畅率的独立影响因素。 Objective To investigate the clinical outcomes of endovascular treatment of complex aortoiliac artery occlusion (AIOD). Method The data of 71 AIOD patients admitted to the Department of Vascular Surgery of Fuwai Hospital from January 2016 to December 2022 were retrospectively analyzed. All of them, 66 males and 5 females with a age of (64.4±8.9) years(range: 39-38 years), were identified as grade D in the second edition of Trans-Alantic Inter-Society Consensus (TASC-II). All patients underwent aortoiliac artery endovascular intervention and their follow-up results were obtained. Univariate and multivariate logistic regression analysis was applied to screen the risk factors affecting post-operative patency rate, and Kaplan-Meier curve was used to analyze the survival rates. Results Sixty patients received first-stage stent implantation and 11 patients received second-stage stent implantation after catheter-directed thrombolysis with a technical success rate of 100%. Among them, 51 patients received kissing stent implantation,7 bare metal stent implantation,2 iliac artery stent implantation combined with fermoral endarerectomy, and 11 covered stent combined with bare metal stent implantation. The average preoperative ankle-brachial index(ABI) was 0.53 ± 0.26, and the postoperative ABI was 0.92 ± 0.21, which was significantly improved (t=27.305,P<0.01). Among the 71 patients, acute stent thrombosis occurred in 2 cases, puncture complications in 3 cases and external iliac artery ruputure in 1 case. A number of 65 cases were followed (91.5%). The median follow-up time was (42.5±21.8) months, during which in-stent restenosis occurred in 12 cases and 1 patient underwent above-knee amputation 1 month after the surgery. The primary patency rate was 81.5% (53/65), the secondary patency rate was 100% and the limb salvage rate was 99% (64/65). Multivariate logistic regression analysis showed that severe calcification was an independent factor affecting postoperative patency rate (OR=9.56,95%CI:1.76~51.77,P=0.01). Kaplan-Meier survival curve showed that the patency rate of patients with severe calcification was lower than that of patients without severe calcification, and the difference was statistically significant (Log-rank χ2=10.038,P=0.01). Conclusion Endovascular treatment of complex AIOD has a high long-term patency rate. Long-term patency rate can be affected by severe calcification.

    主髂动脉闭塞症腔内治疗通畅率

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    股腘动脉中重度钙化病变血管腔内治疗单中心前瞻性研究

    王冰黄砺锐钟文于欣雨...
    267-272页
    查看更多>>摘要：目的 依托于VASCBASE数据库，分析真实世界中伴有中重度钙化的股腘段动脉硬化闭塞症的不同腔内治疗的临床数据和疗效。 方法 收集2021年1月至2022年12月，入组于浙江大学医学院附属第一医院血管外科Evolusion项目（NCT04716361）患者的临床资料。统计患者基线情况，并随访至2023年5月1日，观察不同腔内治疗技术成功率、免于临床驱动的靶病变血运重建（CD-TLR）率、靶病变通畅率、生活质量改善情况等指标。 结果 共纳入患者281例，其中男性194例，女性87例；年龄（73.8±10.7）岁（范围：38~95岁）；其中完全闭塞病变216例（76.9%）。Rutherford分级2级6例，3级148例，4级51例，5级73例，6级3例。踝肱指数为0.32（0.07，0.52），病变长度为（17.5±8.1）cm（范围：2.0~45.0 cm）。靶血管为单纯股浅动脉140例（49.8%），腘动脉与股浅动脉118例（42.0%），其他动脉23例（8.2%）。腔内治疗方式有全程支架覆盖105例（37.4%），单纯药物涂层球囊（DCB）扩张83例（29.5%），单纯DCB预扩张后局部支架植入27例（9.6%），普通球囊扩张后局部支架植入23例（8.2%）及其他治疗方式43例（15.3%）。技术成功率为100%（281/281）。术后穿刺点血肿1例。本组患者均采用电话随访和门诊随访的方式。电话随访满1、3、6及12个月分别为250例（89.0%）、250例（89.0%）、247例（87.9%）、220例（78.3%）。门诊随访满1、3、6及12个月分别为246例（87.5%）、230例（81.8%）、188例（66.9%）、87例（30.9%）。术后1、3、6及12个月时，患者Vasc-QOL评分分别为（5.56±1.18）分、（5.89±0.84）分、（6.09±0.82）分及（6.19±0.93）分，组间比较差异有统计学意义（F=13.91，P=0.001）；EQ-5D-5L评分分别为20（18，20）分、20（19，20）分、20（20，20）分及20（20，20）分，组间比较差异有统计学意义（H=0.005，P=0.001）。术后1、3、6及12个月免于CD-TLR率和一期通畅率分别为96.4%（241/250）、92.8%（232/250）、91.9%（227/247）、89.1%（196/220）和87.8%（216/246）、73.9%（170/230）、61.7%（116/188）、44.8%（39/87）。 结论 伴中重度钙化的股腘段动脉硬化闭塞症，老年男性多见，多为单纯股浅动脉、股浅和腘动脉病变。腔内治疗术式多样，技术成功率高。术后1年主观评分和免于CD-TLR率较高，但总体一期通畅率较低。 Objective To analyze real-world clinical data and efficacy on endovascular interventions for moderate to severe calcification in femoropopliteal arteriosclerosis obliterans based on the database VASCBASE. Methods From January 2021 to December 2022, clinical data on patients enrolled in the Evolusion program (NCT04716361) at the Department of Vascular Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine were collected. All patients, baseline condition gathered, were followed through May 1, 2023. Observations included the rate of technical success, the freedom from clinically driven target lesion revascularization(CD-TLR), the patency rate of target lesion, and the improvement in quality of life. Results A total of 281 patients were enrolled, with 194 (69%) being male and the age being (73.8±10.7) years. Among them, 216 cases were diagnosed with total occlusion. Of all participants, 6 cases were classified as Rutherford category 2 148 cases were classified as category 3 51 cases, category 4 73 cases, category 5 and 3 cases, category 6. The ankle-brachial index (ABI) was 0.32 (0.07,0.52) with an average lesion length of (17.5±8.1) cm. Vascular-targeted therapy was applied for the treatment of mere superficial femoral artery (140 cases 49.8%), popliteal artery together with superficial femoral artery (118 cases, 42.0%), and other arteries (23 cases, 8.2%). Full stent coverage, drug-coated balloon (DCB)dilation, and local stent implantation following DCB pre-dilation or conventional balloon dilation were the most frequently used surgical techniques, accounting for 37.4%(105/281), 29.5%(83/281), 9.6%(27/281), and 8.2%(23/281) of cases, respectively. The rate of technical success was 100% with one postoperative complication (hematoma at the puncture site). Following surgery, the patients were followed up via mobile phone and outpatient services. The follow-up rate via mobile phone was 89.0%, 89.0%, 87.9%, and 78.3% at 1, 3, 6, and 12 months, respectively. The follow-up rate via outpationt service was 87.5%, 81.8%,66.9% and 30.9% at 1,3,6 and 12 months,respectively.At 1, 3, 6, and 12 months, the Vasc-QOL score was 5.56±1.18, 5.89±0.8, 6.09±0.82 and 6.19±0.93, respectively and the EQ-5D-5L score was 20 (18, 20), 20 (19, 20), 20 (20, 20) and 20 (20, 20), respectively, the difference was statistically significant (F=13.91,P=0.001 H=0.005, P=0.001). At 1, 3, 6, and 12 months, 96.4% (241/250), 92.8% (232/250), 91.9% (227/247), and 89.1% (196/220), respectively, of patients were exempted from CD-TLR. Meanwhile, the primary patency rates were 87.8% (216/246), 73.9% (170/230), 61.7% (116/188), and 44.8% (39/87), respectively. Conclusions Moderate to severe calcification of the femoropopliteal occlusive sclerosis primarily affects elderly men risk factors include diabetes, hypertension, obesity, and smoking. Interventional procedures for the lower limbs have a high rate of efficacy and few complications. At one year, the rate of freedom from CD-TLR was greater, whereas the rate of primary patency was lower.

    动脉硬化,闭塞性血管钙化股腘动脉支架药物涂层球囊

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    编织型镍钛合金支架治疗慢性严重肢体缺血的多中心回顾性研究

    李文文毛志君方圆杨沁彤...
    273-277页
    查看更多>>摘要：目的 探讨编织型镍钛合金Supera支架治疗的慢性严重肢体缺血（CLTI）患者的中长期疗效。 方法 回顾性分析 2017年4月至2020年12月复旦大学附属中山医院血管外科、上海市中西医结合医院脉管病科及浙江省温岭市中医院血管外科3家中心采用Supera支架治疗的303例50岁以上CLTI患者的临床资料。其中男性205例，女性 98例；年龄（73.5±9.3）岁。电话随访并收集患者生存情况、临床驱动的靶病变血运重建（CD-TLR）、大截肢和创面愈合情况。采用Kaplan-Meier法绘制生存曲线，以Log-rank检验比较两组患者的生存差异。 结果 χ 296例患者获得随访，随访时间为（23.6±12.9）个月。Kaplan-Meier生存曲线显示术后 6、12、24及36个月总生存率分别为99.0%、96.2%、86.1%、77.4%。术后12、24和36个月免于CD-TLR率分别为94.2%、91.1%和89.6%。随访期内，15例患者接受了大截肢，总保肢率为92.7%（281/303），有效保肢率为94.9%（281/296）。268例术前存在创面的患者中，203例愈合，创面愈合率为75.7%。Kaplan-Meier生存曲线显示创面愈合的患者较未愈合患者生存率高，差异具有统计学意义（Log-rank 2=32.894，P<0.01）。同时，在糖尿病、Meggitt-Wagner分级、Rutherford分级、病变数量及术前流出道数量方面，创面愈合组和未愈合组患者间差异具有统计学意义（P值分别为0.025、0.007、0.005、0.049和0.004）。 结论 运用编织型镍钛合金支架Supera对 CLTI 患者具有提高创面愈合率和提高保肢的临床效果。 Objective To investigate the mid- to long-term outcomes of endovascular treatment with Supera interwoven nitinol stents in patients with chronic limb-threatening ischemia (CLTI). Methods From April 2017 to December 2020, clinical data from 303 CLTI patients aged over 50 years and treated with Supera stent were collected and analyzed retrospectively at three centers including Department of Vascular Surgery of Zhongshan Hospital of Fudan University, Department of Vascular Diseases of Shanghai TCM-Integrated Hospital, and Department of Vascular Surgery of Wenling Hospital of Traditional Chinese Medicine of Zhejiang Province. Among them, there were 205 males and 98 females, with an age of (74.0±10.1) years. Telephone follow-up and collected the overall survival, clinically driven target lesion revascularization (CD-TLR), major amputation, and wound healing. The Kaplan-Meier method was used to draw survival curves and the Log rank test was used to compare the survival differences between the two groups of patients. Results Follow-up was obtained in 296 patients, with a follow-up duration of (23.6± 2.9) months. Kaplan-Meier survival curves showed that the overall survival rates at 6, 12, 24, and 36 months were 99.0%, 96.2%, 86.1%, and 77.4%, respectively. The proportions of patients without CD-TLR at 12, 24, and 36 months were 94.2%, 91.1%, and 89.6%, respectively. During the follow-up period, 15 patients underwent major amputations, with a total limb salvage rate of 92.7% (281/303) and an effective limb salvage rate of 94.9% (281/296). Among 268 patients with preoperative wounds, 203 healed, with a wound healing rate of 75.7%. The Kaplan-Meier survival curve indicated that patients with wounds healed had a higher survival rate compared to those whose wounds did not heal, with a statistically significant difference (Log-rank χ2=32.894, P<0.01). Meanwhile, in terms of diabetes, Meggitt Wagner classification, Rutherford classification, the number of lesions and the number of preoperative outflow tracts, there were statistically significant differences between the wound healing group and the non-healing group (P values were 0.025, 0.007, 0.005, 0.049 and 0.004, respectively). Conclusions The utilization of Supera interwoven nitinol stents in CLTI patients demonstrates clinical benefits in improving wound healing rates and limb preservation.

    慢性严重肢体的缺血编织型镍钛合金支架Supera创面愈合

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    基于Mimics三维重建对下肢动脉硬化闭塞症诊疗的应用研究

    袁鹏程冯永飞刘雪莹饶德新...
    278-284页
    查看更多>>摘要：目的 评估基于Mimics三维重建对下肢动脉硬化闭塞症（LEASO）诊疗的有效性和准确性。 方法 收集河南大学第一附属医院心血管外科2020年1月至2023年3月70例LEASO患者的下肢动脉增强薄层CT及数字减影血管造影（DSA）检查资料，用Mimics软件进行下肢动脉及斑块三维建模，以CT血管造影（CTA）和DSA数据为参照，比较Mimics软件和DSA评估的动脉节段狭窄程度分级、中度及以上狭窄动脉诊断一致率、病变长度、支架直径、外周动脉钙化评分系统（PACSS）分级的情况，比较Mimics和CTA评估的钙化斑块体积、混合斑块钙化百分率的情况。 结果 与DSA结果相比，Mimics诊断动脉狭窄程度的符合率94.29%（792/840），高估率3.81%（32/840），低估率1.90%（16/840），其中对狭窄程度≥50%动脉节段诊断灵敏度为97.19%（311/320），特异度为98.08%（510/520），假阳性率为1.92%（10/520），假阴性率为2.81%（9/320），准确率为97.74%（821/840），Kappa值为0.952。Mimics和DSA对病变长度、支架直径的测量，差异无统计学意义（P>0.05）；Mimics和CTA对钙化斑块体积、混合斑块钙化百分率的测量，差异无统计学意义（P>0.05）。与DSA结果相比，Mimics对PACSS分级的判断符合率95.07%（135/142），高估率1.41%（2/142），低估率3.52%（5/142）。 结论 基于Mimics三维重建模型可直观地显示下肢动脉病变位置，并准确测量狭窄程度、病变长度、血管直径、斑块体积等，对LEASO术前精准诊疗具有指导意义。 Objective To establish a three-dimensional model of lower extremity arteriosclerosis obliterans (LEASO) using Mimics with data from computed tomography angiography (CTA) and digital subtraction angiography (DSA) and to evaluate the safety, effectiveness and accuracy of the diagnosis and treatment of the disease based on the established model. Methods From January 2020 to March 2023, the data of 70 patients with LEASO who underwent enhanced thin-slice CT and DSA examination of lower extremity arteries in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Henan University were collected, and three-dimensional modeling of lower extremity arteries and plaques was performed by Mimics. The stenosis grading in artery segments, diagnostic agreement rate of diseased arteries, lesion length, stent diameter, and peripheral artery calification scoring system (PACSS) grade were compared between Mimics and DSA. The calcified plaque volume and the calcified proportion of mixed plaques were compared between Mimics and CTA. Results The diagnostic coincidence rate of Mimics was 94.29% (792/840) with 3.81% (32/840) of overestimation and 1.90% (16/840) of underestimation. For the arterial segments with a stenosis of at least 50%, the sensitivity (97.19%,311/320), specificity (98.08%,510/520), false positive rate (1.92%,10/520), false negative rate (2.81%,9/320), and accuracy (97.74%,821/840) were obtained. The Kappa coefficient was 0.952, suggesting almost perfect agreement. There was no significant difference in the measurement of lesion length and stent diameter between Mimics and DSA (both P>0.05). There was no significant difference in the measurement of calcified plaque volume and the calcified proportion of mixed plaques between Mimics and CTA (bothP>0.05). The coincidence rate of Mimics in PACSS grading was 95.07% (135/142) with 1.41% (2/142) of overestimation and 3.52% (5/142) of underestimation. Conclusion The three-dimensional reconstruction model based on Mimics can visually display the location of lower extremity arterial lesions, and accurately measure the degree of stenosis, lesion length, vessel diameter, plaque volume, etc., which are significant in accurate preoperative diagnosis and treatment of LEASO.

    动脉硬化闭塞症Mimics三维模型

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    腔内修复术治疗复杂瘤颈成角腹主动脉瘤的中期疗效分析

    伊斯马伊力江·阿卜杜喀迪尔阿布都克尤木·吾甫尔吾甫尔·依马尔王护国...
    285-290页
    查看更多>>摘要：目的 探讨复杂瘤颈成角的腹主动脉瘤（AAA）行腔内修复术的中期疗效。 方法 回顾性分析新疆医科大学第一附属医院2019年1月至2022年1月收治的130例择期行血管腔内修复术（EVAR）治疗的肾下型AAA患者的临床资料，其中男性114例，女性16例。根据近端瘤颈是否属于复杂瘤颈成角将患者分为复杂成角组（59例）和非复杂成角组（71例）。收集两组围术期资料和随访结果，比较两组的瘤颈解剖条件、术中情况及术后随访结果。 结果 两组在性别和D-二聚体水平方面差异有统计学意义［χ 2=6.457，P=0.012；779（615，2 110）ng/ml 比 531（309，905）ng/ml，Z=-2.948，P=0.003］，其他一般资料差异无统计学意义。与非复杂成角组相比，复杂成角组瘤颈长度更短［（3.98±1.67）cm 比（3.38±1.72）cm，t=2.029，P=0.045］，肾上角［（21.97±9.69）° 比（40.30±19.27）°，t=6.645，P<0.001］和肾下角［（40.85±12.61）° 比（70.92±11.58）°，t=14.048，P<0.001］的角度更大，瘤体直径［（4.62±0.93）cm 比（5.76±1.50）cm，t=5.046，P<0.001］也更大，瘤颈血栓化程度更高（χ 2=4.093，P=0.043），差异均有统计学意义。130例患者EVAR手术均获得技术成功（100%）。130例患者均获得随访，随访时间为（13.43±7.69）个月。随访期间，死亡6例，其中复杂成角组和非复杂成角组各3例，均为非动脉瘤相关原因死亡。Ⅰ型内漏7例，其中复杂成角组5例，非复杂成角组2例；Ⅱ型内漏3例，其中复杂成角组2例，非复杂成角组1例；髂支内闭塞4例，复杂成角组和非复杂成角组各2例。两组患者在Ⅰ型内漏、Ⅱ型内漏、Ⅲ型内漏、夹层、髂支内闭塞、再次手术干预、死亡等并发症发生率比较，差异均无有统计学意义（均P>0.05）；但复杂成角组总体并发症发生率高于非复杂成角组，差异具有统计学意义（27.1% 比 12.7%，χ 2=4.327，P＝0.038）。 结论 腔内治疗复杂成角的肾下AAA有效、可行，中期疗效较好。 Objective To investigate the mid-term outcome of endovascular repair for abdominal aortic aneurysm (AAA) with complex aneurysm neck angulation. Methods Data from 130 patients with subrenal AAA who were treated with elective endovascular aneurysm repair (EVAR) in The First Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2022 were retrospectively analyzed, with 114 males and 16 females. The patients were divided into complex angulation group (n=59) and non-complex angulation group (n=71) according to whether the proximal aneurysmal neck was a complex aneurysmal neck angulation or not. The study collected perioperative data and follow-up results to compare the two groups' anatomical conditions of the aneurysmal neck, intraoperative conditions, and postoperative follow-up. Results There were statistically significant differences in gender (χ2=6.457,P=0.012) and D-2 polymer levels [779 (615,2 110) ng/ml vs 531(309,905)ng/ml,Z=-2.948,P=0.003] between the two groups, and there was no statistically significant difference in other general data. Compared with the non-complex angulation group, the length of the aneurysmal neck in the complex angulation group was shorter [(3.98±1.67) cm vs (3.38±1.72) cm, t=2.029, P=0.045], the angles of the superior angle [(21.97±9.69)° vs (40.30±19.27)°,t=6.645,P<0.001] and inferior angle [(40.85±12.61)°vs (70.92±11.58)°,t=14.048,P<0.001] were larger, the aneurysm diameter was wider [(4.62±0.93)cmvs (5.76±1.50)cm,t=5.046,P<0.001], and the proportion of mural thrombus was higher (χ2=4.093, P=0.043), with statistically significant differences. The EVAR procedure was technically successful in all 130 patients (100%). Follow-up was obtained in 130 patients for (13.43±7.69) months. During the follow-up period, 6 cases died, including 3 cases each in the two groups, all of which died of non-aneurysm-related causes. Seven cases had intermediate type I endoleaks, including 5 in the complex angulation group and 2 in the non-complex angulation group. Three cases had intermediate type II endoleaks, including 2 in the complex angulation group and 1 in the non-complex angulation group. And there were 4 cases of intra-iliac branch occlusion, 2 cases each in the two groups. There was no statistically significant difference between the two groups in the incidence of complications such as type I endoleaks, type II endoleaks, type III endoleaks, dissection, intra-iliac branch occlusion, re-operative intervention, and death (all P<0.05). However, the overall complication rate of the complex angulation group was higher than that of the non-complex angulation group, and the difference was statistically significant (27.1%vs 12.7%,χ2=4.327,P=0.038). Conclusion Endovascular repair for AAA with complex aneurysm neck angulation is effective and feasible, with a well mid-term outcomes.

    腹主动脉瘤腔内修复治疗瘤颈成角预后

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