《新英格兰医学杂志》：腹主动脉瘤的治疗（附欧美腹部主髂动脉瘤指南、CTA评估要点

　　Recommendation  101

　　In patients  treated for juxtarenal abdominal aortic aneurysm by endovascular repair, a  thorough long-term follow up programme including annual computed tomography  angiography is recommended.

　　对于以腔内手术修复近肾腹主动脉瘤的患者，推荐终生进行随访，包括每年一次CTA。Recommendation  102

　　The threshold  for elective repair of isolated iliac artery aneurysm (common iliac artery,  internal iliac artery and external iliac artery, or combination thereof) may  be considered at a minimum of 3.5 cm diameter.

　　孤立性髂动脉瘤（髂总动脉、髂内动脉、髂外动脉或多发髂动脉瘤）的择期修复指证的最小直径可以设为3.5cm。Recommendation  103

　　In patients  with iliac artery aneurysm endovascular repair may be considered as ?rst line  therapy.

　　对于髂动脉瘤患者，腔内修复可以考虑作为一线治疗。Recommendation  104

　　Preserving  blood ?ow to at least one internal iliac artery during open surgical and  endovascular repair of iliac artery aneurysms is recommended.

　　在开放或腔内修复髂动脉瘤术中，推荐保留至少一侧髂内动脉血流。Recommendation  105

　　In patients  where internal iliac artery embolisation or ligation is necessary, occlusion of  the proximal main stem of the vessel is recommended if technically feasible,  to preserve distal collateral circulation to the pelvis.

　　对于需要栓塞或结扎髂内动脉的患者，如果技术可行，推荐闭塞近端主干，以保留盆底的远端侧枝血流。Recommendation  106

　　It is  recommended that the diagnosis of a mycotic aortic aneurysm is based on a  combination of clinical, laboratory, and imaging parameters.

　　感染性主动脉瘤，推荐基于临床表现、实验室检查和影像学指标综合进行诊断。Recommendation  107

　　Treatment of  patients with a suspected mycotic aortic aneurysm with intravenous  antibiotics is recommended; empirical antibiotic treatment against  Staphylococcus aureus and Gram negative rods should be initiated as soon as  cultures have been secured, and continued in those with negative cultures.

　　可疑感染性主动脉瘤的患者，推荐经静脉使用抗生素。经验性使用抗生素的同时，葡萄球菌和革兰阴性杆菌应尽早培养分离确认，阴性结果应继续培养。Recommendation  108

　　Mycotic  aneurysm repair is recommended irrespective of aneurysm size.

　　感染性动脉瘤修复不考虑动脉瘤大小。Recommendation  109

　　Surgical  techniques used in mycotic aneurysm repair should be considered based on  patient status, local routines, and team experience, with endovascular repair  being an acceptable alternative to open repair.

　　感染性动脉瘤修复中，开放技术应该在患者状况、所在地区常规流程、团队经验的基础上选择使用，腔内修复作为可接受的替代手段。Recommendation  110

　　Long-term  post-operative antibiotic treatment (6-12 months or lifelong) and  surveillance should be considered after mycotic aneurysm repair.

　　感染性动脉瘤修复术后，应该考虑长期使用抗生素（6-12个月或终身）并随访。Recommendation  111

　　All patients  with symptomatic in?ammatory abdominal aortic aneurysms should be considered  for medical anti- in?ammatory treatment.

　　对于所有有症状的炎性腹主动脉瘤患者，应该考虑抗炎症药物治疗。Recommendation  112

　　In patients  with in?ammatory abdominal aortic aneurysm with a threshold diameter of 5.5  cm and suitable anatomy, endovascular repair should be considered as a ?rst option.

　　对于直径5.5cm以上、解剖合适的、有症状的炎性腹主动脉瘤患者，腔内修复应该作为第一选择。Recommendation  113

　　In all  patients with penetrating aortic ulcer, isolated abdominal aortic dissection,  aortic pseudoaneurysm, or intramural haematoma, medical treatment, including  blood pressure control, is recommended.

　　对于所有穿透性溃疡、孤立性腹主动脉夹层、主动脉假性动脉瘤或壁间血肿的患者，推荐包括血压控制在内的药物治疗。Recommendation  114

　　In  uncomplicated penetrating aortic ulcer, dissection, or intramural haematoma  of the abdominal aorta, serial imaging surveillance is recommended.

　　对于非复杂的穿透性溃疡、夹层或壁间血肿的患者，推荐进行影像学随访。Recommendation  115

　　In patients  with complicated penetrating aortic ulcer, dissection, or intramural  haematoma, and in pseudoaneurysm in the abdominal aorta, repair is  recommended.

　　对于复杂的穿透性溃疡、夹层、壁间血肿或主动脉假性动脉瘤的患者，推荐进行修复。Recommendation  116

　　Early  treatment may be considered for saccular abdominal aortic aneurysms, with a  lower threshold for elective repair than for standard fusiform abdominal  aortic aneurysms.

　　相较标准的纺锤状腹主动脉瘤，囊状（偏心性的）腹主动脉瘤可以考虑降低择期手术的指征，早期治疗。Recommendation  117

　　In patients  with complicated penetrating aortic ulcer, dissection, intramural haematoma,  or pseudoaneurysm of the abdominal aorta, endovascular repair should be  considered as a ?rst option.

　　对于复杂的穿透性溃疡、夹层、壁间血肿或主动脉假性动脉瘤的患者，腔内修复应该考虑作为首选治疗。Recommendation  118

　　Patients with  abdominal aneurysm and concomitant cancer are not recommended prophylactic  aneurysm repair on a different indication (diameter threshold) from patients  without cancer, including cases of chemotherapy.

　　对于伴发癌症的腹主动脉瘤患者（包括化疗），直径指征与无癌症患者相同，不推荐做预防性的动脉瘤修复。Recommendation  119

　　In patients  with concomitant malignancy, a staged surgical approach, with endovascular  repair of a large or symptomatic abdominal aortic aneurysm ?rst, to allow for  treatment of malignancy with minimal delay, is recommended.

　　对于伴发肿瘤的患者，推荐进行分期外科处理：大直径或有症状的腹主动脉瘤先行腔内修复，最短时间桥接肿瘤治疗。Recommendation  120

　　In patients  with concomitant cancer, prolonged low molecular weight heparin prophylaxis  up to four weeks after abdominal aortic aneurysm repair should be considered.

　　对于同时有癌症的患者，应在腹主动脉瘤修复术后，考虑预防性延长使用低分子肝素达4周。Recommendation  121

　　In patients  with abdominal aortic aneurysm in whom the disease cannot be solely explained  by a non-genetic cause, such as patients <60 years or in patients with a  positive family history, genetic counselling is recommended prior to genetic  testing.

　　对于无法单纯用非遗传因素（如大于60岁或者有家族史）解释的腹主动脉瘤患者，推荐先行询问遗传史，优于基因检测。Recommendation  122

　　Referral to a multidisciplinary  aortic team at a highly specialised centre is recommended to manage patients  with an aortic disorder suspected of having an underlying genetic cause.

　　推荐将患者转运给高级别专业性中心的多学科协作主动脉团队，来管理具有潜在遗传性因素的主动脉疾病患者。Recommendation  123

　　In young patients  with suspected connective tissue disorders and abdominal aortic aneurysms,  open surgical repair is recommended as ?rst option.

　　对于可疑结缔组织疾病合并腹主动脉瘤的患者，开放手术推荐作为第一选择。Recommendation  124

　　A  retroperitoneal approach for patients requiring open surgical repair or  endovascular repair if anatomically feasible may be considered as preferred  options for the surgical treatment of abdominal aortic aneurysm with a  co-existing horseshoe kidney.

　　对于腹主动脉瘤合并马蹄肾，解剖合适需要开放或腔内修复的患者，开放手术时可以考虑将腹膜后入路作为最优选择。Recommendation  125

　　Preservation  of the renal isthmus and anomalous renal arteries >3 mm in diameter should  be considered during both open and endovascular repair of abdominal aortic  aneurysm with a co-existing horseshoe kidney.

　　对于腹主动脉瘤合并马蹄肾，进行开放或腔内修复的患者，应该考虑保留峡部和大于3mm的异常肾动脉。