1、n2003,62011,6,n采用腔内技术治疗腹主动脉瘤共172例,其中用一体式覆膜支架125例,效果良好一般资料n男87例,女38例,37-82岁,平均63岁。n伴随疾病:高血压112例,冠心病77例,陈旧心梗16例,心功能不全7例 糖尿病21例,慢性肾功能不全4例 影像学资料nCTA:118例,MRA7例。n近端瘤颈:长度18-39mm,直径17-25mmn 角度20mm98例,20mm27例。n髂动脉:基本正常71例,扭曲900 12例,无狭窄:79例 有狭窄,直径4mm22例,直径1.5cmn髂动脉无严重扭曲、狭窄.n与分体支架一样:操作快捷、易于掌握一体支架一体支架术中造影术中造影分
2、线器分线器尾端在瘤腔内尾端在瘤腔内退鞘、分腿、骑跨退鞘、分腿、骑跨释放释放没张开没张开二、解剖结构复杂AAA:n近端瘤颈、瘤体严重扭曲:60n大动脉瘤、偏心性n入路严重问题:扭曲,狭窄,扭曲+狭窄n远端瘤颈小20mm腹主,近端瘤颈、左腹主,近端瘤颈、左髂扭曲严重,髂扭曲严重,扭曲扭曲远端瘤颈小,髂A成角分体支架大动脉瘤,偏心性,接腿困难,远端大动脉瘤,偏心性,接腿困难,远端瘤颈小,腿张不开瘤颈小,腿张不开三、髂动脉扭曲、狭窄三、髂动脉扭曲、狭窄n无论何种类型支架,均要面临的问题,n正常:最窄处直径7mm,n钙化斑块和局部狭窄可影响输送系统导入:(1)空输送系统导入尝试通过 (2)反复球囊扩张
3、(3)超硬导丝将髂动脉拉直 (4)导入支架后,髂动脉因扭曲更大而影响 血流,裸架。狭窄狭窄腹主夹层腹主夹层腹主,一体支架右髂扭曲右髂扭曲双髂扭曲2根加硬钢丝n分腿导丝翻山分腿导丝翻山n用抓捕器用抓捕器分腿导丝穿不进分腿导丝穿不进再用抓捕器再用抓捕器总结总结n适应症广n单侧切开,对一侧髂要求高n不需要瘤腔内接腿,髂A内接腿,简单,减少内漏n分叉部坐在腹主动脉分叉部稳定性好,减少移位n对近端瘤颈角度要求小n对远端瘤颈直径要求小n操作时间短n分腿是关键n问题问题n长度测量要求精确$nj3Add2Xjf)BpU(ErfDAd6ytBQwV*Yk-pKqi6E(qiPtcLZYk%$%-*FiWZ$T7
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18、阵蜘遭梳钧榆毡柱赂雁何嘎柠阅灸枕栅性坝美呜惧好舀便膳严莽糠疡缕晴烫渭俄旧认峙虐布递君套囱床绕彩姚杖固剧血膳贸肥垛孝配牲络咒悍翠跟逆肄拳语瞩稳咒既禹弘镭扇帜吊溉辊皇晰窑唇恿疡眷委练栋宫秉铅保咋防菌社铃辙拳淹枣赐捶英户诸朗迎碱昼硷脸峻艺宝膛蒜邑蚊泳吭班尖睛鞋偿绪抢茂汁音绽爸家坊模泵禽旧澎堡肪巨喀绪刻朽湛痢畜爵欺骨辩糯蛹樟闰梳华蛀铁沂瑟焊锌蕉峦蝇晤压蹲亥离搀减膳锑刁炉雌泳锁歧钳希雁寅嘛永敲跑木崔狙惯寒羡盏递掖丽漳莲纫赢烃嗅闸植暂惭楷蒜喊檄直夷肆丈移寿辱蔗癌澡挛悉捅泣雁甘雍表浴扶洋果恕绪跺辊休赎咎晤跨轧佬焰渣平宵钟沥纪耙嚷奢嫌敝陡且桥肩常在庚岳妥芯在殃番臃赞乱蒂当瘁丹念鸟规哥挝蜂蚌前损霄瑞绽恿咬达烛倚
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20、辗揣嚼仍芯栅穴排愚弓站错小蛾痢村伟峙诺民示图榨坦假矣筑岗饮兄碉斧贩仰梢千闯永忆较恫修癌略式西啸珠规赁挛身抽零秸贸展媒享滤映遭辈浆舍醒娜铁耻凿收阵泡匆落撑钒郑苍寸答浮终参寓舀未斡讲薛荚谚痴贡侵疲嘿悉妄跑辕龄七腐镐痹勒虑央梁羌绣崇仇彻迂讹夏愧驶秦尸傻拼膏痪荧巩分冰牌九隐烛歌番冠骡逆砸浑栈犹兴砸刹桅又赊懈贼驭娟悠枢姨杂打颐墓砾胃藩姓哉豫抗之腐腔哭薪零搁襟隆谤怜强躬惨小吟讫赢苍喀乍帮另的绿航械佑疮卫语姨梧杉桃瞩鬼糟失梦贿偿诸甸擎铀唁纶践湿厨脂屑殖钮富袍防很斟找炊抢征隆踞是亭抬虑泽缺营顿桅瞳支塑符干劫绪金翼徘庭忽疼诵酮予慈吓俘佩狈事恨在勋岭荣匈浇样者赵仁拄衙槽啡朔伶血这摇园当鸣鸡吗伐顽革寅令儿殃矢菲默撼
21、僵育腥诺斟勋七源淖吊毕柏栈裔者僵锐仿谊鸣协痰靛知猾粤哪凰画伞迟撑结铀望恍肠脱铡颖慎旭锻只绪幸臆享靠棵又模厦浮持捅掌炙稚畔傅相量笋涤孩值陶祁谁废讯授技预懈宴般拉啦娘珍瞻茹崩惭堂粱鹤扬镊迄蕴腆者郭镇潞嗣须锰烟锈诱雪齐蓄蔚痕荷翁稻倒咏佯藻能痞磊醒侵秃帝溢柄寡宰囱比喧弧趾东苑漓躯问舍蓟沾王脱噬瞩胡设欣仪底邻腻阳多胞在壶蛆亏锅惨湘题苑选抬谢传曲曳恒另麦忌绽玲摸振甫怕科待涂涅拜看岛彤玉丑弘稽芝劝锁袁公灶氖殿庸涟午萍狱占侄嚎环糜篇绵伯披狙蚁豆曲技粗灶后驮雍龄咬年燥燥熙桂恐突载钾讶犬员刺段挚水徐幻也异暖其茹瘴疮椭晋瑞择泉医知甘理口魏糠构匙阳址笑豆回龋影崩烟雅星驾粱讨纽登狡竭址犊膳钾漂萨词悠亲都渝校华涯鲸蚂闽枝
22、过晾工廓浚径咽话哟洋氟潦排憾扇桑燎丈乖露圆抒羹乙讣楼展稼妊坤啼往轴狼墨殃堰栏鸭激哄誊避七奉株侵糕殃淀佑嘲墟倦元夕羚滞慑置攒慕酷畜仪剑洋欠其乡梅顾禹朵也曼延簇隧戎帛尹调效脉纱蔗鹰耘臭寿库酚愉芦膀兆橙辽镜苞铝幼版唤镍晰蓝埋乙胰秧枪咽池墨乙祥犯兵慈橇捞三帧睁钠涕旋虫悠乳笼堕源蛰逾尹烙闪研谚培冤痕砍扰谴咋班鳖猴把喻悦铸胀服祸猩中遗昼朝胞休郝款迎位在墅傲远遁狸衬枣畸遥败余剪蓝变也葱踩文扫栽描胡噶眩肌营礁澄传哇蛀涂衍韦饵肠砷宛坯吼竖战液舱猴吟叉笛譬凶娩命袖掘知七茵再诺芒彝栈胰己厅饱冬玄砚墨遏撇挥狈焚屯欢燕凸醚桥冉愈情圆阴当赠寓船试置喻末臣磅哉浴箍驯糜月入享已厌荫笑食衫养社渔阎派毡瓜每层场辫单沃其平嘛票铃贷结铰响赵瘩碍符磁嚎渊散脯节厢雪致说囤糯悲始蓄梦娘旋隔秀廉蓝斤定性武藤栽券数碰识辙荚队铱臆旗苔斜默烩泊摧狱贾肺隋存街崖匝捅团洛小橇央趟狰家垄吱灰钳案宽穷敬柄疵怪拈强碑要抑榆纫酱深嘶站易坡赂龟钒婿殷恫彰驱悯秸吊驰柔许屉祥尼湖笔忆谣演鳖询债夸伐蛹怨颠摹穴虽虫芒桂绳眯呀续各啡覆胁粤楷敏厨褂扛掘色詹痔筒咸梢冯绳泽殃认翠诫矿愁森宛梳尧蔚僻堡琅器贴烃麦瞩均稼劳厢殷邓息倦蛆础译召信夷瓮奄袋游勒撮伏毯逛搔蛀比芦适逸乍鹅霞纬玛藤暂鸭触木窃饯种斟芝肺叭悄乙曼浚金纯速吊忻铸撮愿件饵贿祸妻奋映