PDF(Pubmed)
Abstract：
There have been significant technologic advances in endovascular aortic therapies since the introduction of conventional infrarenal endovascular aortic aneurysm repair (EVAR). These advances have sought to address the weaknesses of conventional EVAR- particularly the difficult or \"hostile\" infrarenal aortic aneurysm neck. We review anatomical features that create a hostile neck and the most recent advancements to overcome these limitations. EndoAnchors replicate open suture fixation to seal endograft to aortic tissue and have been shown to be useful as a prophylactic measure in short, angulated necks as well as therapeutic for type Ia endoleaks. Fenestrated EVAR (FEVAR) devices such as the Z-fen (Cook Medical, Bloomington, IN, USA) raises the seal zone to the suprarenal segment while maintaining renal perfusion. Finally, multibranch aortic grafts such as the Thoracoabdominal Branch Endoprosthesis (Tambe; W. L. Gore & Associates, Flagstaff, AZ, USA) raise the seal zone above the visceral segment and can be used off the shelf with promising results.
摘要：
自从引入常规肾下血管内主动脉瘤修复术（EVAR）以来，血管内主动脉治疗技术取得了重大进展。这些进展试图解决传统EVAR的弱点-特别是困难的或“敌对的”肾下主动脉瘤颈部。我们回顾了形成敌对颈部的解剖学特征以及克服这些限制的最新进展。EndoAnchors复制开放式缝线固定以将移植物密封到主动脉组织，并已被证明可用作预防措施，成角度的颈部以及治疗Ia型内漏。开窗式EVAR(FEVAR)设备，如Z-fen(CookMedical，布卢明顿,IN,USA）在维持肾脏灌注的同时将密封区升高到肾上段。最后,多分支主动脉移植物，如胸腹分支内假体(Tambe；W.L.Gore&Associates，弗拉格斯塔夫,AZ,USA）将密封区提高到内脏段以上，可以现成使用，效果很好。
