EVAR术后II型内漏相关动脉的应用解剖学研究
Applied anatomy of the type II endoleak relevant arteries after endovascular aneurysm repair
目的 为栓塞EVAR术后II型内漏侧支或(和)瘤囊提供解剖学依据。 方法 在30具成人尸体标本(男性18具，女性12具)上对肠系膜上下动脉、腰动脉、骶正中动脉、髂内动脉、髂腰动脉及可能出现的副肾动脉的始端外径、位置、走行、距主动脉分叉距离及与相关夹角进行观测和统计学分析；并对其临床意义进行初步讨论。 结果 肠系膜上动脉、肠系膜下动脉均起自腹主动脉前壁，位置固定，变异较少，矢状位与腹主动脉夹角分别为50°，23°；所有标本中边缘动脉均完整、无变异或缺如，未发现Riolan弓；观测中发现2例有副肾动脉，出现率6.7%，起始及发起高度变异较大；腰动脉、骶正中动脉的数量以及位置相对固定，腰动脉位置对应其椎体稍下方走行，与髂腰动脉有吻合现象；髂内、外动脉夹角甚小（26°）或为0°，两者几乎平行下降。 结论 掌握EVAR术后II型内漏的反流动脉解剖学特点的是插管栓塞治疗的先决条件，术中应根据II型内漏的反流动脉分布、吻合变异情况选择不同的栓塞途径和方法，以获得较好的治疗效果。
Objective To provide anatomic basis for transarterial embolization or transcaval embolization type II endoleak after endovascular aneurysm repair (EVAR). Methods The outer diameters of the beginning end, position, tendency, distance to abdominal aorta furcation and relevant included angle of the following arteries of 30 adults corpses (18 male, 12 female) were observed and analyzed statistically: the superior mesenteric artery(SMA)and inferior mesenteric artery(IMA), lumbar artery(LA), median sacral artery, internal iliac artery, iliolumbar artery and accessory renal artery possibly appearing, and the clinical significance was initially discussed. Results Both SMA and IMA originated from the anterior aortic wall with fixed location and less variation. Their included angels with abdominal aorta were respectively 50° and 23°. For all the specimens, the marginal arteries were observed without variation and absence, however, arc of Riolan was not found. Accessory renal arteries were observed in 2 bodies (frequency: 6.7%) with big differences in the beginning and originating height. The number and location of the lumbar artery and median sacral artery were relatively fixed. The lumber artery had the same tendency with the inferior part of its vertebral body and anastomosed with the iliolumbar artery. The included angel of the internal and external iliac artery was small（26°）or even 0°with almost parallel descent. Conclusions Understood the anatomy characteristics of patent sac contraflow artery due to transarterial embolization type II endoleak, were the precondition of transarterial embolization treatment. In order to get better therapeutic efficacy, different embolization channels and methods are suggested to be chosen on the basis of the distribution and anastomosis variation of patent sac contraflow artery of type II endoleak.
Ⅱ型内漏 / 肠系膜下动脉 / 肠系膜上动脉 / 腰动脉 / 经动脉栓塞 / Riolan弓 / 应用解剖
Type II endoleak / Inferior mesenteric artery / Superior mesenteric artery / Lumbar artery / Transarterial embolization / Arc of Riolan / Applied anatomy
[1] Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysm
[J]. Ann Vasc Surg, 1991.5(6): 491-499.
[2] Madden N，Baril DT,Wertz R,et a1.Endovascular abdominal aortic aneurysm repair: a community hospital’s experience
[J].Vasc Endovascular Surg.2009，43(1):25-29.
[3] White GH, Yu W, May J. "Endoleak"-Aproposed new terminology to describe in complete aneurysm exclusion by an endoluminalgraft(1etter)
[J].J Endovasc Surg,1996,3(2):124-125.
[4] Veith FJ，Baum RA，Ohki T. Nature and significance of endoleaks and endotention: summary of opinions expressed at an international conference
[J].J Vasc Surg,2002,35(5):1029-1035.
[5] Politz Jk, N ewmanVS, Stewart MT．Late abdominal aortic aneurysm after AneuRx repair：a repaort of three cases
[J]．J Vasc Surg,2000,31(3)：599-606．
[6] Cao P, De Rango P, Verzini F, et al. Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair
[J].J Cardiovasc Surg , 2010, 51(1):53-69.
[7] 叶开创，陆信武，李维敏，等．经动脉栓塞治疗腹主动脉瘤患者腔内修复术后持续性Ⅱ型内漏的荟萃分析
[J]．中华医学会杂志，2008，25(88): 1732-1735.
[8] Schie GV，Sieunarine K，Holt M，et a1．Successful embolization of persistent endoleak from a patent inferior mesenterie artery
[J]．J Endovasc Surg,1997,4(3): 312-315．
[9] Nevala T, Biancari F, Manninen H, et a1.Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization
[J]. J Cardiovasc Intervent Radiol, 2010,33(2):278-284.
[10] Jonker FH, Aruny J, Muhs BE. Management of type II endoleaks: preoperative versus postoperative versus expectant management
[J]. Semin Vasc Surg, 2009, 22(3):165-171.
[11] 程邦昌，昌盛，黄杰，等．结肠代食管术中结肠血管结构的研究
[J]．中华医学杂志，2006，86(21)：1453-1456．
[12] 王新江，蔡祖龙，赵绍宏，等．Riolan动脉弓的CTA影像表现
[J]．中国临床医学影像杂志，2007，18(2)：101-103．
[13] Chao CP, Paz-Fumagalli R, Walser EM, et a1. Percutaneous protective coil occlusion of the proximal inferior mesenteric artery before N-butyl cyanoacrylate embolization of type II endoleaks after endovascular repair of abdominal aortic aneurysms
[J]. J Vasc Interv Radiol,2006 ,17(11):1827-1833.
[14] Lee JH, Lee KH, Chung WS, et al. Tranacathcter embolizafion of the middle sacral artery：collateral feeder in recurrent rectal bleeding
[J].AJR,2004,182(4)：1055-1057．
[15]Baum RA, Carpenter JP, Golden MA, et a1.Treatment of type 2 endoleaks after endovascular repair of abdominal aortic aneurysms：Comparison of transarterial and translumbar techniques
[J].J Vasc Surg, 2002, 35(1):23-29．
[16]Buth J, Laheij RJF．Early complications and endoleaks after endovascular abdominal aortic aneurysm repair：repo rt of multicenter study
[J]．J Vase Surg, 2000, 31(1 pt 1)：134-146．
[17] Herkowitz HN. Rothman-Simeone The Spin
[M]．6th ed. 科学出版社，Harcourt，W.B.Saunders，2001:50-58.
[18] 郑晓晖，陈振光，林海滨，等. 腰椎后外侧部血供的应用解剖学研究及临床意义
[J]．中国临床解剖学杂志，2004,22(4):340-343.
[19]Singh AK, Sahani DV. Imaging of the renal donor and transplantrecipient
[J].Radiol Clin North Am, 2008, 46(1):79-93.
京ICP备08002354号-3/
| 〈 |
|
〉 |
