摘要目的 探讨烟囱技术腹主动脉瘤腔内修复术(chimney-endovascular aneurysm repair,ChEVAR)应用的中长期结果.方法 回顾性分析北京大学人民医院2011年1月至2016年12月采用烟囱支架技术行EVAR手术患者的临床资料.结果 本组21例患者中男18例,女3例,年龄平均74.0 ±6.31岁(62～83岁).1例围手术期死亡,20例患者中位随访时间54.2个月.21例患者中1例行双侧肾动脉烟囱支架,14例行左侧烟囱支架置入,6例行右侧烟囱支架置入.技术成功率100％;术前血清肌酐与术后1周比较差异无统计学意义(P =0.639),术前估测肾小球滤过率与术后1周比较差异无统计学意义(P =0.804);术前、术后动脉瘤直径分别为(60.1 ±13.1)mm和(59.2±13.5)mm,差异无统计学意义(P =0.826).随访期间5例患者死亡,无主动脉相关事件;发现1例Ⅱ型内漏保守观察;烟囱支架通畅率100％.结论 对于高手术风险的不良瘤颈腹主动脉瘤患者,腔内修复手术联合烟囱技术是安全和有效的选择.

abstractsObjective To evaluate the mid-and long-term results of chimney-endovascular aneurysm repair (Ch-EVAR) on efficacy and durability.Methods Data of abdominal aortic aneurysm (AAA) patients receiving Ch-EVAR were retrospectively collected and analyzed.Results From Jan 2011 to Dec 2016,21 patients received Ch-EVAR in our institution including 18 males and 3 females with the average age 74.0 ±6.31 years.One patient died and 20 patients were followed up for an mean period of 53.2 months.During EVAR procedures 14 patients received left renal artery chimney stents,6 patients had right renal artery chimney stents and one did bilateral renal artery chimney stents.Technical success was achieved in all patients (100％).Differences between preoperative and one-week postoperative value of serum creatinine (P =0.639) and estimated glomerular filtration rate (eGFR) (P =0.804) showed no statistical difference.The differences of maximum sac diameter between preoperiation (60.1 ± 13.1 mm) and follow-up (59.2 ± 13.5 mm) was not significant (P =0.826).Six patients died during follow-up and none was aortic events related.All chimney stents were patent.One patient developed late type Ⅱ endoleak and refused reintervention regardless of aneurysm expansion.Conclusion For short hostile neck AAA patients with considerable surgical risk Ch-EVAR may be an effective and durable alternative.