2018 年第 3 期 第 13 卷

血管内超声对腹主动脉瘤腔内修复术中Ⅰ型内漏的诊断价值

Diagnostic value of intravascular ultrasound for type Ⅰ endoleak in endovascular repair of abdominal aneurysm

作者：张腾飞唐小斌杨耀国吴小凡何楠王晓娜陈忠

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单位：100029首都医科大学附属北京安贞医院血管外科

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• 摘要：

• 目的    探讨血管内超声（IVUS）对腹主动脉瘤腔内修复术（EVAR）中Ⅰ型内漏的诊断价值。方法    选取2014年7月至2017年2月首都医科大学附属北京安贞医院血管外科收治的行EVAR的肾下性腹主动脉瘤患者16例，男11例、女5例，平均年龄（66±3）岁，术中数字减影血管造影（DSA）显示存在内漏，用IVUS观察覆膜支架的贴壁情况；记录内漏发生的位置。结果    16例患者均顺利完成EVAR及IVUS观察，成功率100%。DSA诊断11例患者为Ⅰ型内漏，IVUS发现近端支架贴壁不良，10例为Ⅰ型内漏，1例考虑膜漏（Ⅳ型内漏）可能性大；4例患者DSA无法确定内漏类型，怀疑Ⅰ型内漏，IVUS考虑膜漏（Ⅳ型内漏）。1例患者DSA发现内漏，IVUS不能判断是否贴壁良好，通过CODA球囊后扩张发现内漏消失。随访3～6个月，均未出现内漏。受试者工作特征曲线显示IVUS发现支架贴壁不良与内漏发生高度相关（P=0.027）。结论    IVUS显示贴壁不良与DSA发现内漏符合率很高，IVUS能够比较准确地发现支架贴壁不良的位置，间接更好地明确内漏的位置。

• Objective    To investigate the value of intravascular ultrasound(IVUS) in diagnose of type Ⅰ endoleak in endovascular aneurysm repair(EVAR) of abdominal aortic aneurysm. Methods    Sixteen patients, including 11 males and 5 females with abdominal aneurysm undergoing EVAR were enrolled from July 2014 to February 2017 in Beijing Anzhen Hospital, Capital Medical University; the average age was （66±3）years. Intraoperative digital subtraction angiography(DSA) showed endoleaks in all patients; IVUS was used to observe the position of stent graft. Results    All 16 patients successfully completed EVAR and IVUS; the success rate was 100%. Eleven patients were diagnosed of type Ⅰ endoleak by DSA; IVUS showed proximal stent malapposition, 10 cases were confirmed as type Ⅰ endoleak and 1 case was suspected membranous leak(type Ⅳ endoleak). Four patients were suspected type Ⅰ endoleak by DSA and they were suspected membranous leak(type Ⅳ endoleak) by IVUS. One patient with endoleak diagnosed by DSA could not be confirmed by IVUS, and the endoleak disappeared after CODA ballon dilation. No endoleak occurred in 3-6 months after operation. The receiver operating characteristic curve showed a high correlation between stent malapposition disgnosed by IVUS and the occurrence of endoleak(P=0.027). Conclusions    tent malapposition diagnosed by IVUS shows a high coincidence with endoleak disgnosed by DSA; IVUS can show the position of stent graft to help accurately find the location of endoleak.