FEVAR手术纠正了大动脉的危险弱化

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, 我们的播客邀请了来自纽约中部唯一的学术医疗中心的专家. I'm your host, Amber Smith.

一位血管外科医生最近加入了上州医科大学的外科，他提供了一种独特的、侵入性较小的修复腹主动脉瘤的方法.

Dr. 李伟在这里向大家解释这个手术是如何工作的，以及它对哪些病人最有帮助.

Welcome to "The Informed Patient," Dr. Li.

Wei Li, MD: Thank you for that introduction, and as Amber said, my name's Wei Li, and I'm a new vascular surgeon, but also, this is my return to Syracuse. 18年前我曾是外科住院医师, 然后我继续我的培训之旅和我的职业生涯, until now, 我回到上州，重新回到大学和医院工作.

Host Amber Smith: So, welcome back to Syracuse. Now, 在我们讨论手术细节之前, 让我们回顾一下什么是腹主动脉瘤. Where is this located in the body?

Wei Li, MD: It's in the abdomen, 位于人体最大的动脉, which is called (the) aorta, 基本上它是主动脉的扩张(扩大到超过正常大小). The medical term's "aneurysmal change."

基本上，它就像血管膨胀的气球. And the bigger the balloon, 气球破裂的可能性越大, 哪些是动脉瘤患者的主要风险. However, 还有一些与动脉瘤有关的其他症状, 如血凝块可以从动脉瘤的内表面移出，我们称之为附壁血栓，并向远端移出，阻塞病人的腿或肠子.

One of my patients in Texas, two years ago, he had an aneurysm discovered, 但他在急诊室发现了腿部血管闭塞. 后来我们发现他的腹部有一个很大的动脉瘤.

Host Amber Smith: So, let me make sure I understand this. The aorta, the biggest artery in the body, that carries the blood, if there's a weakness, and it starts ballooning, there's risk with that, 但它也有可能导致血液凝块，然后在身体的其他部位引起其他问题.

Wei Li, MD: That's correct. 尽管与第一种情况相比，第二种情况要少得多, but they do exist as well, 所以当病人四肢冰凉的时候, sometimes they do have a big, enlarged abdominal area in the body, although it's rare. But they do exist.

Host Amber Smith: So what are the symptoms? 一个人怎么知道他们的腹部有动脉瘤呢, and how much of an emergency is it?

Wei Li, MD: Unfortunately, most of the abdominal aneurysm patients, 直到动脉瘤破裂或出现症状他们才知道, just like the gentleman I mentioned. 现在，从过去的20年开始，我们对动脉瘤有了更多的认识. 所以我们开始用超声波进行监视(使用声波的测试)..

我们现在在实践中提供的一件事是使用超声波来筛查有吸烟史的人, who is older than 65 years old, and, also who may have family history, 意思是说其他家庭成员曾经或正在患这种动脉瘤.

Host Amber Smith: So a person who's older, you said over 65, 也许是家族成员有动脉瘤病史或吸烟史的人, those people might be at higher risk. 所以你可能会做监视你随机观察他们是否有动脉瘤, even though they don't have any symptoms.

Wei Li, MD: That's correct. 有些人称之为无声杀手因为他们向急诊室表现为低血压, abdominal pain, and then, on scan, ultrasound or CT (an imaging method), we found the ruptured aneurysm, 这可能是病人第一次或最后一次知道他们有动脉瘤, unfortunately, became a mortality.

Host Amber Smith: 所以，假设你提前发现了动脉瘤，在它引起症状或问题之前. How is it traditionally dealt with? How do you treat it?

Wei Li, MD: 我们不治疗任何动脉瘤，直到这些动脉瘤达到一定的大小，例如5.5 or 6 centimeters in male patients. Traditionally, probably 20 years ago or 30 years ago, 我们用开腹手术治疗那些动脉瘤, which were major surgery. To this day, we still offer those kinds of surgery, 但大多数时候我们都有足够的条件通过导管来治疗动脉瘤(导管在一个小的, 空心管)，腹部无大切口.

Host Amber Smith: So tell me more about how this is done. 如果它能避免让病人接受大手术的话, 你可以用最小的侵入性来做这件事, right, with smaller incisions? 这在动脉瘤的情况下是如何起作用的呢?

Wei Li, MD: Thanks to the new technology, 我们可以从两个腹股沟穿过小针孔插入一个叫做血管内主动脉移植的装置, 所以这些移植物可以从内部覆盖动脉瘤, so the aneurysm will not get enlarged, 会不会被血压推或压, and prevent rupture.

Host Amber Smith: 你能比较一下开放式腹动脉瘤修复术和微创手术的恢复情况和成功率吗?

Wei Li, MD: 哦，与30年前相比，这是一个巨大的不同. So 30 years ago, we'd do open abdominal aneurysmal repair, patients, most of them, stayed in the hospital a week, 甚至在退伍后也有严重的残疾情况. Now, most people, if we repair the aneurysm electively, 大多数病人第二天就能出院.

Host Amber Smith: 这里是纽约州推荐最近最火的赌博软件的“知情患者”播客. I'm your host, Amber Smith.

I'm talking with Dr. Wei Li. He's a surgeon at Upstate, 他提供了一种微创动脉瘤修复术这是开放手术的另一种选择.

那么，我们来谈谈哪些病人最适合这个手术.

有腹主动脉瘤的人可以寻求这种微创的选择吗?

Wei Li, MD: Almost anyone, given the advancement of technology, because compared to 10, 20 years ago, 现在我们有更多的移植物和更多类型的操作和设备.

我想说大概90%以上的腹主动脉瘤患者都能从这种最低限度的基础技术中受益.

Host Amber Smith: 有什么东西会取消一个人的资格吗? 病人的体型重要吗，还是动脉瘤的大小重要?

Wei Li, MD: In rare occasions, for example, 病人的解剖结构非常罕见，我们称之为“短颈”," or for example, they have no neck, we call "aneurysm neck." In that kind of situations, 我们可能要进行传统的开放式手术, but those situations are very rare.

Host Amber Smith: 它的简称是FEVAR，但它代表着某种东西:F-E-V-A-R. What does that stand for?

Wei Li, MD: 与常规EVAR(血管内动脉瘤修复)相比，开窗腹主动脉腔内修复术是一项稍密集的技术, 这意味着我们可以用分支技术(一种变体)治疗动脉瘤, 意思是如果脖子比平均长度短, 我们可以用更先进的移植物来治疗. 这项技术是新的，但不是很新. 我从2013年开始做这项技术. The technology became available, 2012年获得美国食品和药物管理局(FDA)批准.

Host Amber Smith: 所以我很好奇你是如何指导将要做这个手术的病人的.

How do you tell them to prepare for it? 是否有测试或测量必须提前完成?

Wei Li, MD: 我认为大部分的测试/准备工作都是在医生方面进行的, and for the patients, it's nothing specific. 我想大多数情况下，病人只是在做了一些血液检查后，在手术当天来到医院.

Host Amber Smith: 这个过程通常需要多长时间?

Wei Li, MD: Normally a couple hours. 如果我们做开窗EVAR (FEVAR)，可能需要三到四个小时. 但如果是普通的EVAR，通常是几个小时.

Host Amber Smith: 在手术过程中病人是否清醒?

Wei Li, MD: Most of the patients are not awake. We do this under general anesthesia. 在整个过程中，病人甚至不知道他们做了手术.

Host Amber Smith: How long is the hospital stay afterward?

Wei Li, MD: 大多数情况下都是过夜，病人第二天就可以回家了.

Host Amber Smith: 你需要注意哪些类型的并发症?

Wei Li, MD: 最常见的是我们称之为"接触相关"因为那些腹部动脉瘤患者, most of them are smokers, 所以他们的血管更硬，有斑块, 有时，这种接触可能非常具有挑战性.

And the more challenging the access, 出现血肿等并发症的几率更高, meaning bleeding, or, sometimes, 它可能导致第二次去手术室。. 另一件事是感染的可能性，但与开放式手术修复相比，感染的可能性要小得多.

Host Amber Smith: How long is the graft meant to last?

Wei Li, MD: That was a good question 30 years ago. 我们从20世纪90年代开始做这种手术. Those grafts last very, very long. The newer grafts are better, 老的移植类型往往有一些移植相关的并发症. 随着时间的推移，它们会逐渐消失，但较新的往往会持续更长时间. And, 考虑到患者年龄在60到70岁之间, probably, 我们希望移植能持续到他们的余生.

Host Amber Smith: 我很好奇后续护理是什么样的. 做过这个手术的病人会继续和你联系吗, 还是回到他们的初级保健医生那里?

Do they have to be followed closely?

Wei Li, MD: 因为我们已经做了20多年了, 我们有一套关于如何跟进这些病人的方案. 根据具体情况，大多数病人都可以接受超声波或CAT扫描. They do need to return to the hospital, normally one week after surgery, to check their wounds, and in one month to check the graft, with either CAT scan or ultrasounds. 也可以用CAT扫描进行对比(一种特殊的染料). And then depending on the situation, 人们每隔三到六个月或一年回来一次, every year.

Host Amber Smith: 我猜如果你的病人还在吸烟，你会建议他们戒烟.

这对他们的康复有影响吗?

Wei Li, MD: It does. 吸烟甚至是任何增长的一个重要因素, so for people who have a small aneurysm, 如果患者停止吸烟，则不建议修复该尺寸, 他们的研究表明，吸烟会加速动脉瘤的生长. 然后对病人停止吸烟或者对任何人都建议戒烟, with any vascular pathology.

Host Amber Smith: Well, Dr. 李，我很感谢你抽出时间告诉我们这个选择. Thank you.

Wei Li, MD: Thank you.

Host Amber Smith: My guest has been Dr. 李伟，北州医院专门从事血管和血管内手术的外科医生.

“知情的病人”是一个关于健康的播客, science and medicine, 由锡拉丘兹上州医科大学为您带来, New York, and produced by Jim Howe. 在upstate找到我们之前的剧集.edu/informed.

我是主持人安珀·史密斯，感谢大家的收听.