Open surgery is essential for the treatment of complex abdominal aortic aneurysms.

On August 29, 2020, the 8th Northwest Aortic Disease Summit Forum was successfully held in the form of a combination of online live and offline, and the majority of vascular surgeons discussed and shared their experiences on hot issues in the field of aortic disease.
Statistics, the incidence of abdominal aortic aneurysm is about 20 to 40 cases per year / 100,000 people, because of the disease led to 65 to 74 years of age mortality rate of about 1.7%, ruptured abdominal aortic aneurysm mortality rate as high as 80 to 90%, seriously threatening the lives of patients.
blood supply to internal organs must also be considered when treating a near-renal abdominal aortic aneurysm.
treatment of abdominal aortic aneurysms, which are extremely distorted in the neck, is also a major difficulty.
Lu Yanying of Vascular Surgery at Xi'an Jiao university's First Affiliated Hospital was invited to be interviewed about the treatment strategy of complex abdominal aortic aneurysms.
: Abdominal aortic aneurysm is one of the common diseases of vascular surgery, once ruptured, the death rate as high as 70% to 95%, seriously threatening the health and life of patients.
would you like to share your treatment strategy for abdominal aortic aneurysm? And how to choose? Professor Lu Yanying: For the treatment of abdominal aortic aneurysm patients, the first drug conservative treatment should be used to inhibit the growth of abdominal aortic aneurysm.
, tumor diameters of 5 cm or 4.5 cm (Asian female patients) can be controlled by blood pressure, blood sugar, lipids, smoking cessation and other risk factors to achieve the goal of inhibiting tumor growth.
if the tumor is growing rapidly in a short period of time, or serious complications occur, such as rupture tendency, remote embolism, organ isoemia, etc., surgical intervention is required.
, surgical treatment mainly includes open surgery and in-cavity surgery.
there is still no uniform standard for these two options.
generally, for young patients with strong tolerance, open surgery is preferred, while in-cavity surgery is recommended for elderly patients with poor tolerance, heart, lung and brain function.
It should be noted that for some complex abdominal aortic aneurysms such as cervical distortion, stenosis, too short, tired internal arteries, poor entry vascular conditions, etc., it is difficult to treat with in-cavity surgery;
, the choice of surgical strategy should take into account the experience of the physician, the patient's situation and personal will, as well as the hardware conditions of the hospital.
Clinic: For near-end aneurysm neck shorter near-renal abdominal aortic aneurysm, involving the visceral artery area, the conventional abdominal aortic aneurysm cavity repair effect is not ideal.
are the treatment options available for this type of lesions? Prof. Lu: For the treatment of abdominal aortic aneurysms that affect the internal organ area, conventional EVAR surgery covers the internal arteries during the release of the stent, leading to ischemic internal organs.
, it is generally available to improve the way of medical equipment by using special in-cavity techniques to achieve the purpose of treatment.
Common techniques include chimney stents, window scaffolding, custom window stents, etc.: 1) Chimney technology (parallel stent technology): that is, by placing chimney stents in the kidney arteries, abdominal cavity dry or intestinal membranes to ensure internal blood supply.
Although the technology is simple to operate, the surgical equipment is less limited, but prone to Ia-type internal leakage; 2) in-body pre-window technology: by vascular surgeons before surgery according to the patient's image data to modify the existing stent;
3) Custom window bracket: by precisely opening the window holes in the internal organ area corresponding to the main bracket, positioning is more accurate and there are fewer leakages, while solving the problem of insufficient anchoring.
but custom window brackets are expensive and take a long time to wait.
it important to note that the more window holes there are, the higher the risk of leakage and the risk of thrombosis in the branch stent.
the continuous modification of in-cavity medical appliances to accommodate more complex abdominal aortic aneurysms is the goal of joint efforts by vascular surgeons and medical appliance manufacturers.
with the development of in-cavity technology and appliances, the application prospects of multi-branch stents and multi-window stents will be more broad, and the success rate of in-cavity surgery will be improved.
for the treatment of complex abdominal aortic aneurysms, in-cavity techniques are used, the operation is complex, time-long, costly, and physicians and patients need to be exposed to radiation for long periods of time.
, on the other hand, many of the patients who come to our hospital are generally in poor financial condition.
if the patient's heart and lung function is appropriate, open surgery will generally be used for treatment.
addition, hybrid surgery can use artificial blood vessels to reflow the internal arteries, and then use a cladding stent to cover the lesions throughout, is also a widely used technique.
, the experience of each physician is different, as long as the patient is fully evaluated before surgery, the use of their most skilled technique is a reasonable treatment strategy.
Clinic: The extremely distorted abdominal aortic aneurysm has long been a difficult part of treatment.
would you like to share some surgical techniques for treating such lesions? Prof. Lu: The extremely distorted abdominal aortic aneurysm is one of the difficulties in treatment.
need to be emphasized that the extremely distorted abdominal aortic aneurysm is a taboo for intra-cavity treatment, and that in the event of complications, the consequences are unimaginable.
For patients who are unable to withstand other procedures and can only be treated with in-cavity technology, it is recommended: 1) select a strong plastic, anchored stent;
for the treatment of such lesions, open surgery can achieve good long-term results, and simple operation, low cost.
recent years, surgical-related medical equipment and anesthesia technology has been developed by a large amount, and now open surgery does not mean a huge innovation.
, advances in the concept of rehabilitation have accelerated the recovery of patients after surgery.
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