根據(jù)2005年1月邁阿密海灘(FL, USA)舉行的每年一度的國際血管內(nèi)治療論壇的資料：破裂血管瘤的血管內(nèi)微創(chuàng)修復正在越來越普遍，避免了許多手術修復的危險。

絕大多數(shù)破裂的動脈血管瘤，叫做腹部動脈血管瘤(AAAs)，起源于主動脈壁的薄弱區(qū)域。隨著時間的流逝，循環(huán)血壓能夠?qū)е卤∪鯀^(qū)域膨脹，象個氣球一樣。隨著大小的增加，動脈壁變得越來越薄弱，破裂的機會也在增加。平均而言，大約有40-50％需要打開腹腔修補動脈流的患者死亡。有時候，醫(yī)生建議在血管瘤破裂之前選擇修補治療。大約5％的選擇修補手術的患者死亡，大約2％進行選擇性血管內(nèi)修補的患者死亡。破裂的動脈血管瘤是一種急癥，需要緊急處理但是風險極大。

在論壇上報道的資料涉及476例接受血管內(nèi)修補的血管瘤破裂患者，其中19％（91例）死亡而81%得以存活。而由于血管瘤破裂接受外科手術死亡患者在40-50％。血管內(nèi)修補需要將一個叫做內(nèi)支架的設備從腹股溝血管插入動脈。血流被移植物重新改變方向，這樣血管瘤的壓力得以減輕。由于這種治療方法越來越受到歡迎，適合不同需要不同尺寸的內(nèi)支架已經(jīng)上市，因此在急診時選擇合適尺寸已不再成為問題。

阿爾貝特愛因斯坦醫(yī)學院(New York, NY, USA)外科副主任Frank J.Veith教書評論說：“微創(chuàng)血管內(nèi)修補避免了許多外科手術的危險。大約三分之二需要手術治療破裂動脈血管瘤的患者可以選擇這種治療方法。”
在內(nèi)支架修補之前和之中醫(yī)生可以通過限制液體灌注從而將血壓降至低水平。Veith醫(yī)生說：“這就限制了出血，這種方法我們叫做低血壓止血法，我們已經(jīng)發(fā)現(xiàn)十分有效。”
 
Endovascular Repair of Ruptured Aneurysms
 
Minimally invasive endovascular repair of ruptured aortic aneurysms is increasingly common and avoids many of the risks of surgical repair, according to data presented at the annual International Symposium on Endovascular Therapy in Miami Beach (FL, USA) in January 2005.

Most ruptured aortic aneurysms, known as abdominal aortic aneurysms (AAAs), begin with a weakened area in the wall of the aorta. Over time, the pressure of circulating blood can cause the weakened area to swell, like a balloon. As the size increases and the walls of the aorta become thinner, the chance of rupture grows. On average, about 40-50% of patients who have open surgery for a ruptured aortic aneurysm die. Sometimes, a doctor will recommend that the balloon be electively repaired before it ruptures. About 5% of patients undergoing elective surgery die, and about 2% die during elective endovascular repair. A ruptured aortic aneurysm is an emergency and urgent treatment is necessary but much riskier.

Data were presented at the symposium on 476 patients who received endovascular repair for burst aneurysms, of whom 19% (91) died and 81% survived. This is in contrast to the 40-50% of patients who die following surgery for a ruptured aortic aneurysm. Endovascular repair involves threading a device called an endograft through a blood vessel in the groin and into the aorta. The flow of blood is redirected through the graft so the pressure on the aneurysm is relieved. As this therapy has become more popular, more options and sizes of endografts have become available, so obtaining the appropriate size in an emergency is no longer a concern.

“Minimally invasive endovascular repair of the rupture avoids many of the dangers of surgery,” commented Frank J. Veith, M.D., professor and vice chairman of the department of surgery at Albert Einstein College of Medicine (New York, NY, USA). “As many as two-thirds of patients who need treatment for a ruptured aortic aneurysm could be candidates for this technique.”

Doctors allow a patient’s blood pressure to fall to low levels before and during endograft repair by restricting fluid resuscitation. “This limits the bleeding, and we have found this approach, which we call hypotensive hemostasis, to be very effective,” added Dr. Veith.