Complications and treatment of follow-up period after treatment in the abdominal aortic aneurysm cavity

EVAR has become the main treatment method of abdominal aortic aneurysm because of its advantages of small trauma, less bleeding and rapid postoperative recovery.
with the accumulation of experience and the gradual improvement of equipment, operating technology is maturing, treatment adaptation certificate is more extensive.
although the risk of peri-surgical period in EVAR patients is greatly reduced, there are still more problems during follow-up period, which require close follow-up and, if necessary, further surgical intervention.
at the 8th Xiangya Vascular Forum held in Changsha, Professor Zhao Jichun from Vascular Surgery, Huaxi Hospital, Sichuan University, gave a wonderful speech on the complications and treatment of follow-up period after treatment of abdominal aortic aneurysm cavity.
EVAR postoperative complications include internal leakage, titer cysts, stent shift, stent distortion, stent infection and tumor rupture, among which internal leakage is the most common.
factors of internal leakage include tumor neck length, tumor neck calcification degree, tumor neck angle, stent-related factors, etc.
For I.a type leakage, it can be observed first, the leakage disappears or the leakage does not increase and the tumor does not increase to continue clinical observation;
, O'Neill and others have shown that the use of extended brackets can reduce the risk of type I leakage by 65%.
for type .b type I leakage can be operated on again to extend the leg.
for type II internal leakage, tumor tumor during follow-up increased, feasible spring ring embolism treatment.
risk of type II leakage includes a continuously smooth IMA, a smooth lumbar artery, and the largest aneurysm diameter.
a 2013 study showed a 10.2% risk of type II leakage, of which 35.4% closed themselves and 0.9% of type II leakage caused the aneurysm to rupture.
arterial puncture embolism is the most common treatment method of type II. type leakage, commonly used embolism fillers include spring ring, stainless steel spring ring, protein glue and so on. the causes of thrombosis in the stent after
EVAR surgery include calcification or stenosis of the fork part of the aorta, an angle or stenosis of the near end of the total artery, distortion of the anatomy path of the artery, discount or pressure of the stent, excessive overlap area of the stent diameter, and the location of the outer artery at the far end of the artery mezzanine or anchoring area.
treatment methods include in-cavity thrombosis, suction hydrants, balloon dilation and stent implantation or arterial indentation hydrants, arterial bypassing.
retrospective study showed that extending leg stents to the arteries outside the armpits increased the risk of leg thrombosis and amputation.
single-center clinical data retrospective analysis of Sichuan University Huaxi Hospital vascular surgery between June 2011 and December 2018 completed 567 patients with intracaneal abdominal aortic aneurysm intracarosis, 1, 3, 6, 12 months after surgery and subsequent annual outpatient follow-up abdominal color super, CT vascular reconstruction review.
follow-up time was 1 to 96 months, the overall mortality rate was 8.3%, the aneurysm-related mortality rate was 2.4%, the re-intervention rate was 3.7%, the main complications were leakage (with type II. type leakage the most) and renal artery stenosis (Table 1).
case 1 (male, 78 years old) in cases of postoperative complications in Table 1 EVAR: 3 years after EVAR surgery.
: Near-end and far-end leaks.
surgery strategy: spring ring embolism cavity and right titer artery.
after surgery: the leakage improved significantly.
case 2 (female, 55 years old) current medical history: 8 months after EVAR surgery, CT found 21 days of leakage in type I.a.
: Near-end leak.
surgical strategy: implanting a Cuff stent in the near-terminal tumor neck.
postoperative created: the inner leak disappears.
case 3 (male, 70 years old) current medical history: 1 year after EVAR surgery.
CT: Artery closure.
surgery strategy: two-sided artery bridge.
the micro-invasive advantages of EVAR during peri-surgical period.
assessment of abdominal aortic aneurysms and the development of an individualized and precise surgical program are the primary factors for surgical success.
but the complications of EVAR postoperative follow-up period were more than open surgery, of which the infusion and stent graft thrombosis were the most common.
treatment will affect long-term efficacy, so regular lifelong follow-up after surgery and timely treatment of related complications is necessary.
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