内支架修补破裂血管瘤

根据2005年1月迈阿密海滩(FL, USA)举行的每年一度的国际血管内治疗论坛的资料：破裂血管瘤的血管内微创修复正在越来越普遍，避免了许多手术修复的危险。

绝大多数破裂的动脉血管瘤，叫做腹部动脉血管瘤(AAAs)，起源于主动脉壁的薄弱区域。随着时间的流逝，循环血压能够导致薄弱区域膨胀，象个气球一样。随着大小的增加，动脉壁变得越来越薄弱，破裂的机会也在增加。平均而言，大约有40-50％需要打开腹腔修补动脉流的患者死亡。有时候，医生建议在血管瘤破裂之前选择修补治疗。大约5％的选择修补手术的患者死亡，大约2％进行选择性血管内修补的患者死亡。破裂的动脉血管瘤是一种急症，需要紧急处理但是风险极大。

在论坛上报道的资料涉及476例接受血管内修补的血管瘤破裂患者，其中19％（91例）死亡而81%得以存活。而由于血管瘤破裂接受外科手术死亡患者在40-50％。血管内修补需要将一个叫做内支架的设备从腹股沟血管插入动脉。血流被移植物重新改变方向，这样血管瘤的压力得以减轻。由于这种治疗方法越来越受到欢迎，适合不同需要不同尺寸的内支架已经上市，因此在急诊时选择合适尺寸已不再成为问题。

阿尔贝特爱因斯坦医学院(New York, NY, USA)外科副主任Frank J.Veith教书评论说：“微创血管内修补避免了许多外科手术的危险。大约三分之二需要手术治疗破裂动脉血管瘤的患者可以选择这种治疗方法。”
在内支架修补之前和之中医生可以通过限制液体灌注从而将血压降至低水平。Veith医生说：“这就限制了出血，这种方法我们叫做低血压止血法，我们已经发现十分有效。”
 
Endovascular Repair of Ruptured Aneurysms
 
Minimally invasive endovascular repair of ruptured aortic aneurysms is increasingly common and avoids many of the risks of surgical repair, according to data presented at the annual International Symposium on Endovascular Therapy in Miami Beach (FL, USA) in January 2005.

Most ruptured aortic aneurysms, known as abdominal aortic aneurysms (AAAs), begin with a weakened area in the wall of the aorta. Over time, the pressure of circulating blood can cause the weakened area to swell, like a balloon. As the size increases and the walls of the aorta become thinner, the chance of rupture grows. On average, about 40-50% of patients who have open surgery for a ruptured aortic aneurysm die. Sometimes, a doctor will recommend that the balloon be electively repaired before it ruptures. About 5% of patients undergoing elective surgery die, and about 2% die during elective endovascular repair. A ruptured aortic aneurysm is an emergency and urgent treatment is necessary but much riskier.

Data were presented at the symposium on 476 patients who received endovascular repair for burst aneurysms, of whom 19% (91) died and 81% survived. This is in contrast to the 40-50% of patients who die following surgery for a ruptured aortic aneurysm. Endovascular repair involves threading a device called an endograft through a blood vessel in the groin and into the aorta. The flow of blood is redirected through the graft so the pressure on the aneurysm is relieved. As this therapy has become more popular, more options and sizes of endografts have become available, so obtaining the appropriate size in an emergency is no longer a concern.

“Minimally invasive endovascular repair of the rupture avoids many of the dangers of surgery,” commented Frank J. Veith, M.D., professor and vice chairman of the department of surgery at Albert Einstein College of Medicine (New York, NY, USA). “As many as two-thirds of patients who need treatment for a ruptured aortic aneurysm could be candidates for this technique.”

Doctors allow a patient’s blood pressure to fall to low levels before and during endograft repair by restricting fluid resuscitation. “This limits the bleeding, and we have found this approach, which we call hypotensive hemostasis, to be very effective,” added Dr. Veith.