Effect of balloon occlusion combined with intra-sac injection of thrombin in the treat-ment of ruptured abdominal aortic aneurysm
10.19723/j.issn.1671-167X.2024.06.017
- VernacularTitle:球囊阻断联合瘤腔内凝血酶注射治疗破裂腹主动脉瘤
- Author:
Shilu ZHAO
1
;
Jingyuan LUAN
1
;
Qichen FENG
1
;
Qijia LIU
1
;
Guangxin YANG
1
;
Zichang JIA
1
;
Jinman ZHUANG
1
Author Information
1. 北京大学第三医院介入血管外科,北京 100191
- Publication Type:Journal Article
- Keywords:
Ruptured abdominal aortic aneurysm;
Balloon occlusion;
Thrombin;
Endovascular repair
- From:
Journal of Peking University(Health Sciences)
2024;56(6):1052-1057
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the safety and effectiveness of balloon occlusion and intra-sac thrombin injection in the endovascular repair of ruptured abdominal aortic aneurysm.Methods:From October 2019 to October 2022,the clinical data of 16 patients with rAAA treated with balloon occlusion technique and intra-sac thrombin injection combined with EVAR were retrospectively analyzed,including 13 males and 3 females,aged 42-85 years,with a median age of 70.5 years.The time of preoperative first aid(from hospital arrival to operation start),average operation time,stay in intensive care unit(ICU),average hospitalization time,success rate of surgical treatment,perioperative(30 d)mortality rate,incidence of complications,the maximum diameter and volume change of the aneurysm were observed and recorded.Results:Among the 16 patients with ruptured abdominal aortic aneurysm,the technical success rate was 100.0％(16/16).One patient died of multiple organ dysfunction 6 hours af-ter operation.The success rate of surgical treatment was 93.8％(15/16).The preoperative first aid time was(53.3±6.2)min,the average operation time was(89.9±17.1)min,the stay in the intensive care unit(ICU)was(1.7±0.8)d,and the average hospitalization time was(7.8±1.3)d.The intrao-perative balloon occlusion time was(32.4±4.1)min.The postoperative renal function of all the pa-tients had no significant deterioration compared with that preoperative.Abdominal compartment syndrome(ACS)occurred in 1 patient after operation,which improved after CT puncture and drainage.The medi-an follow-up time was 36 months.During the follow-up period,1 patient died of acute myocardial infarc-tion 2 years after operation,and the remaining 14 patients survived.Among the 14 follow-up patients,1 type Ⅱ endoleak occurred,and no other types of endoleak occurred.By the end of the follow-up,the maximum diameter of the aneurysm sac in 14 patients was significantly lower than that before operation[(44.6±8.0)mm vs.(66.0±15.5)mm,P＜0.001],and in 12 patients with CTA,the volume of the aneurysm sac was significantly shrunk than that before operation[(311.7±170.3)mm3 vs.(168.6±68.1)mm3,P＜0.05].Conclusion:Balloon occlusion during endovascular repair is safe and effective in the treatment of ruptured abdominal aortic aneurysm;intraoperative thrombin injection of the aneurysm sac can significantly reduce the incidence of intraoperative and postoperative abdominal compartment syndrome and endoleak and,to a certain extent,improve the success rate of treatment.
