| Part I Treatment Strategies for Endovascular Repair of High-risk and Complex Abdominal Aortic AneurysmObjective: Discussion on the treatment strategies for endovascular repair of patients with high-risk and complex abdominal aortic aneurysm (AAA).Methods:Select61cases of high-risk and complex AAAfrom155patients with AAA, who had been cured in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology during the period from January2009to December2012, then collect and collate the clinical data of these patients, retrospectivelysummarize and analyze the clinical data in these aspects: preoperative examination and evaluation, operation technique, postoperative treatment and follow-up.Results:Detailed evaluation of the conditions of patients had been accomplished before the operation, diverse treatment plans had been taken according to the differences between individual patients in perioperative period, a variety of endovascular technique and new interventional equipment had been use during the operation, after patients discharged from hospital regularfollow-up had been carried on. Two cases of61patients had implemented hybrid operation, all techniques of endovascular abdominal aortic aneurysm repair (EVAR) had successfully completed, and operation success rate was100%. Four patients had implemented emergency operation for ruptured aneurysm,1case died of1case died from hemorrhagic shock, and perioperative mortality was1.6%. Sixty-one main bodies and78iliac limbs of stent-graft,12renal artery stents, and8iliac or femoral stents had been used during the operation. There were11cases with endoleak in perioperative period, including2cases of type I and9cases of type II, the incidence of endoleak was1.8%;2cases with intraoperative dissection of iliac artery,1case with postoperative pseudoaneurysm of femoral artery, these cases had been cured by appropriate measures. The follow-up period ranged from2months to48months, the mean time was (17.8±13.9) months,19cases lost follow-up, the percentage of follow-up was68.9%. In the follow-up period, there were13cases with endoleak, including3cases of type I and10cases of type II, the incidence of endoleak was31.0%;1case with stent-graft migration and2cases with stent-graft obstruction occurred during the same period;1case had implemented second intervention operation because of aneurysm rupture. A total of6patients died, whose deaths were unrelated to AAA, overall survival rate was85.7%.Conclusions:EVAR is a feasible method for the treatment of patients with high-risk and complex AAA. Detailed preoperative evaluation, sufficient preoperative preparation, individual perioperative treatment, regular follow-up are necessary measures to ensure the successful treatment of patients with high-risk and complex AAA. PartⅡ An Analysis of Clinical Curative Effect for Endovascular Repair of High-risk and Complex Abdominal Aortic Aneurysm Objective:To Evaluate the clinical curative effect by using endovascular repair for treatment of patients with high-risk and complex AAA.Methods:Collect and collate the clinical data of155patients suffered AAA, who had been cured in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January2009and December2012, divide patients into two groups:high-risk and complex group versus ordinary group, contrast the patients of two groups in general condition, perioperative period treatment and follow-up result, and analyze the differences between these two groups.Results:There were61patients in high-risk and complex group versus94patients in ordinary group. The mean age of the patients in high-risk and complex group was older than ordinary group ((68.4±13.5) years>(63.3±11.2) years), the percentage of the patients with pain, the mean diameter and the mean length of the aneurysms in high-risk and complex group were higher than ordinary group (37.7%>22.3%,(5.9±1.5) cm>(4.8±1.2) cm,(9.4±2.1) cm>(7.9±1.8) cm), the differences between this two groups had statistical significance (P0＜0.05). Four patients had implemented emergency operation in high-risk and complex group, including1cases of death, perioperative mortality was1.6%; there was no case of emergency operation and death in ordinary group. The number of patients with endoleak in high-risk and complex group versus ordinary group were11cases versus16cases during perioperative period, the incidence of endoleak were18.0% versus17.0%; the number of patients with vascular injury in these two groups were3cases versus1case during perioperative period, the incidence of vascular injury were4.9% versus1.1%; the mean length of hospital stay in these two groups were (6.8±6.2) days versus (5.9±4.1) days. The mean time of follow-up in high-risk and complex group versus ordinary group were (17.8±13.9) months versus (18.5±13.3) days, the percentage of follow-up were68.9%versus64.9%; the number of patients with endoleak in these two groups were13cases versus17cases during follow-up period, the incidence of endoleak were31.0% versus27.9%; the number of patients with stent-graft obstruction in these two groups were2case versus0case during follow-up period, the incidence of stent-obstruction were4.8%versus0%; overall survival rate in these two groups were85.7%versus91.8%. The results showed the differences had no statistical significance in the above aspects between these two groups, which were demonstrated by statistical analysis of these data.Conclusions: EVAR is a reliable method for the treatment of patients with high-risk and complex AAA. Compared with patients with ordinary AAA, almost all index of clinical curative effect for patients with high-risk and complex AAA during perioperative and follow-up period had no statistical significance. |
PDF Full Text Request