摘要目的 总结单中心应用纤维蛋白胶栓塞治疗腹主动脉瘤腔内隔绝术中Ⅰ型内漏的经验,研究其可行性及长期有效性.方法 2002年8月至2010年6月953例接受腹主动脉瘤腔内隔绝术的患者中,51例(5.4％)使用纤维蛋白胶栓塞术治疗术中Ⅰ型内漏.其中男性45例,女性6例,年龄49～88岁,平均年龄(72±8)岁.在栓塞术前后监测瘤腔内压力,在术后3、6和12个月及此后每年采用CT血管造影对患者进行随访.结果 经过栓塞治疗之后,50例(98.0％)Ⅰ型内漏消失,瘤腔内收缩压、舒张压、平均压、脉压差和平均压力指数均有明显降低.围手术期3例死亡(5.9％),其中1例高龄患者是由于Ⅰ型内漏无法消除,转开放手术后死于多器官功能衰竭;另2例死因与主动脉疾病无关.48例获得长期随访,中位随访时间45个月,腹主动脉瘤最大径从术前的(62±15)mm减至(49±10)mm(P =0.000).随访过程中3例患者死亡,其中1例死于瘤体持续增大压迫肾动脉造成的肾功能衰竭,另2例死因与主动脉无关;这3例患者随访期CT血管造影均未发现内漏.结论 纤维蛋白胶栓塞能有效治疗腹主动脉瘤腔内隔绝术中的Ⅰ型内漏,未见与栓塞治疗相关的并发症.在栓塞术前阻断内漏入口近端血流能增强该操作的安全性和有效性.

abstractsObjective To analyze the long-term results of fibrin glue embolization to eliminate type Ⅰ endoleaks after endovascular aneurysm repair (EVAR),and to assess the feasibility and durability of this technique.Methods From August 2002 to June 2010,among the 953 EVAR patients,51 ( 5.4％ )patients underwent intraoperative transcatheter fibrin glue sac embolization to resolve type Ⅰ endoleak persisting after initial intraoperative maneuvers to close the leak or in necks too short or angulated for cuff placement.Computed tomographic angiography was performed to assess the outcome after 3,6,and 12 months and annually thereafter.A retrospective study was conducted,and characteristics of the patients,intra-sac pressure,hospital course,and long-term outcomes were recorded. Results Among the 51 patients,19 (37.3％ ) patients had proximal necks long ＜10mm,and 6 ( 11.8％ ) patients had proximal neck angulation＞60°; 22 patients (3 additional iliac extension,14 cuffs,and/or 8 stents) had been placed with additional devices.After fibrin glue injection,50 (98.0％) of the 51 endoleaks were successfully resolved,and intra-sac pressure (including systolic,diastolic,mean pressures,pulse pressure,and the mean pressure indexes ) decreased significantly in these cases.The patient who failed embolotherapy was converted to open surgery (2.0％) ; he died 2 months later from multiorgan failure.And other two (4.8％) patients died in the peri-operative period from myocardial infarction.The median of follow-up of 48 patients was 45 months (range 4-106 months).The mean maximal aneurysm diameter fell from the baseline (61.5±15.2)mm to (48.8 ± 10.1 ) mm (P=0.000).Three (6.2％ ) patients died in the follow-up duration (1 aneurysm-related,died of renal failure which was caused by the compromised renal artery).Cumulative survival was 97.9％ at 1 year,94.5％ at 3 years,and 90.8％ at 4 years.No recurrent type Ⅰ endoleak or glue-related complications were observed in follow-up.Conclusions Fibrin glue embolization to eliminate type Ⅰ endoleak after EVAR has yielded promising results in this study,and it can effectively and durably resolve the type Ⅰ endoleaks.Balloon occlusion of the inflow of the endoleak must be done during glue injection,to enhance the safety and facilitate formation of a structured fibrin clot.