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目的 :血管内覆膜内支架放置修补术治疗腹主动脉瘤要求近端瘤颈长度 15～ 2 0mm。通过比较术前术后DSA和CT结果 ,探讨跨肾动脉放置支架治疗短瘤颈的腹主动脉瘤对肾动脉的影响。方法 :13例腹主动脉瘤患者行经皮血管内覆膜内支架修补术 ,支架的裸露部分跨过肾动脉开口位置。术前 1周内DSA 13例 ,术后DSA 2 0例。采用多层面螺旋CT或双螺旋CT ,增强扫描图像采用MIP重建腹主动脉和肾动脉。结果 :近端瘤颈长度 5 .0～ 3 0 .3mm (平均 18.5mm )。术前DSA示 2例患者 3支肾动脉狭窄 ,其中左侧 1支 ,右侧 2支 ,狭窄程度约 5 0 %。术后DSA显示 2 5支肾动脉开口均为支架裸露部分遮盖 ,2例共 3支肾动脉狭窄 ,与术前比较 ,狭窄的部位与程度均无明显变化。术前CTMIP显示4支肾动脉狭窄 ,管腔直径狭窄程度约 5 0 %。术后 1个月CTMIP显示 3例出现内漏 ,4支肾动脉狭窄 ,狭窄程度无明显变化。 3个月后 ,12例CT检查未出现新的狭窄。结论 :跨肾动脉放置覆膜内支架治疗腹主动脉瘤对肾动脉形态学无明显影响 ,对具有一种以上外科手术高危因素的患者是一种有效的介入治疗方法
Objective: Intravascular endovascular stent placement repair of abdominal aortic aneurysm requires proximal neck length 15 ~ 20mm. By comparing the results of preoperative and postoperative DSA and CT, to explore the trans-renal artery stent placement of the short neck aneurysm of the abdominal aorta on the renal artery. METHODS: Thirteen patients with abdominal aortic aneurysm underwent endovascular stent-graft repair. The exposed portion of the stent straddles the opening of the renal artery. DSA 13 cases within 1 week before operation and DSA 20 cases after operation. Multi-slice spiral CT or double-helical CT was used to enhance the scan images using MIP to reconstruct abdominal aorta and renal artery. Results: The length of proximal neck was 5.0 ~ 3.0 mm (mean 18.5 mm). Preoperative DSA showed 2 cases of 3 patients with renal artery stenosis, of which 1 on the left, 2 on the right, stenosis of about 50%. Postoperative DSA showed that 25 renal arteries were covered with bare scaffolds, and 2 had a total of 3 renal artery stenoses. No significant changes were found in the site and extent of stenosis compared with those before surgery. Preoperative CTMIP showed 4 renal artery stenosis, lumen diameter stenosis of about 50%. One month after operation, CTMIP showed three cases of endoleak, four renal artery stenosis, no significant changes in the degree of stenosis. Three months later, no new stenosis occurred in 12 cases of CT. Conclusions: Placement of the stent graft across the renal artery in the treatment of abdominal aortic aneurysms has no significant effect on the morphology of the renal artery and is an effective interventional treatment for patients with more than one risk factor for surgical procedures