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目的:探讨近肾腹主动脉瘤(JAA)腔内修复术(EVAR)中肾动脉烟囱技术的价值。方法:2013年6月至2016年6月间,对24例JAA采用EVAR治疗,年龄范围58~81岁,平均(70.9±8.6)岁,其中男性23例;合并高血压21例,糖尿病11例,冠心病9例。瘤颈长度范围1.7~10.5mm,平均(6.0±4.3)mm,因瘤颈锚定距离不适于标准的腔内修复方案,而行肾动脉烟囱支架置入术,以延长瘤颈长度使之符合EVAR要求,同时有效保护肾动脉,然后再完成标准EVAR操作。结果 24例手术全部获成功,成功率100%。24例患者使用31枚肾动脉支架,其中左侧肾动脉烟囱术22例,右侧肾动脉烟囱术1例,双肾烟囱1例。结果:20例患者AAA瘤腔隔绝良好,4例因存在近端1型内漏而置入Cuff支架,共5枚;所有患者肾动脉血流良好。随访2~26个月,平均13.3个月,无死亡病例,肾动脉烟囱支架通畅,3例近端少量1型内漏术,随访瘤体无增大,1例肱动脉穿刺处假性动脉瘤形成,转外科修复;1例股动脉夹层形成,随访观察中。术前与术后1月肌酐值无明显差异(P>0.05)。结论:肾动脉烟囱技术治疗近JAA技术成功率较高,并发症率及病死率较低,是传统EVAR技术的有效补充。
Objective: To investigate the value of renal artery chimney technique in endovascular repair of near-renal abdominal aortic aneurysms (JAA). Methods: From June 2013 to June 2016, 24 cases of JAA were treated with EVAR, ranging in age from 58 to 81 years with an average of (70.9 ± 8.6) years, of whom 23 were male; 21 with hypertension, 11 with diabetes , Coronary heart disease in 9 cases. The neck length ranged from 1.7 to 10.5 mm with an average of (6.0 ± 4.3) mm. Due to the non-optimal neck anchoring distance for standard endovascular repair programs, renal artery chimney stenting was performed to extend the neck length to match EVAR requirements, while effectively protecting the renal artery, and then complete the standard EVAR operation. Results All the 24 cases were successful. The success rate was 100%. Thirty-two renal artery stents were used in 24 patients, including 22 cases of left renal artery chimney, 1 case of right renal artery chimney and 1 case of double kidney chimney. RESULTS: Twenty patients had a well-isolated tumor of the aneurysm, and 4 had Cuff stent placement in 4 due to the presence of proximal type 1 endoleaks. All patients had good renal blood flow. All the patients were followed up for 2 to 26 months with an average of 13.3 months. No deaths were found. The renal artery chimney stents were unobstructed. A small amount of type 1 endoleak was found in 3 cases. There was no significant increase in the size of the tumor. One case of pseudoaneurysm Formed, transferred to surgical repair; 1 case of femoral artery dissection formation, follow-up observation. No significant difference was found between preoperative and postoperative January creatinine (P> 0.05). Conclusion: The success rate of near-JAA technique for renal artery chimney technique is high, and the complication rate and mortality rate are low. It is an effective supplement to the traditional EVAR technique.