2.2. Methods

Patients in the observation group received EVR: After general anesthesia, select the side of the patient with unobstructed iliac artery and make a longitudinal incision under the inguinal ligament along the femoral artery with a length of about 5 cm. A 3 cm long segment of the common femoral artery was dissected and passed through a hemostatic sling at both ends for standby. Under direct vision, the femoral artery was punctured using the Seldinger method, and valved guide sheaths were inserted respectively (GORE, USA). The left and right brachial artery approaches were incised; To avoid internal endoleak caused by reflux of the celiac trunk artery, embolization of the celiac trunk artery should be performed first during the operation. A catheter was inserted into one side of the femoral artery and reserved in the tumor body for coil embolization in case of internal endoleak after branch reconstruction. The stent was inserted into the main body of the abdominal aorta through the left femoral artery and released above the tumor. The iliac branch stent in the main short leg was connected through the right femoral artery. A long sheath was implanted through the left brachial artery. Through the long sheath, 9 mm × 10 cm and 6 mm × 15 cm VIABAHN were implanted into the superior mesenteric artery and the right renal artery respectively using the loach guide wire. The left renal artery from the long leg side through the right brachial artery was chosen and 6 mm × 10 cm VIABAHN and corresponding lined bare support were implanted. Connect the iliac branch inside the long leg, and connect the iliac branch to the aortic bifurcation at the distal end to complete the repair of thoracoabdominal aortic aneurysm. Immediate angiography revealed a slight internal leak at the connection of the branch stent, so a coil was implanted through a reserved catheter for embolization. After confirming that the tumor has been completely isolated, the bilateral femoral artery incisions were transversely sutured with 5–0 prolene suture, and the incisions were sutured layer by layer. Antibiotics were administered postoperatively to prevent infection.

The control group underwent laparotomy: a median abdominal incision was taken under general anesthesia, soft tissue was separated layer by layer, and the peritoneum was incised. After opening, the tumor diameter and bilateral iliac arteries were freed. Locate the abdominal aorta below the renal artery and cut it off. Cut the tumor and remove the mural thrombus and plaque; The anterior wall of the abdominal aorta was cut open and the openings of the ligated lumbar artery, middle sacral artery, and inferior mesenteric artery with recurrent bleeding were sutured. Select suitable artificial blood vessels for abdominal aortic reconstruction, and combine the artificial blood vessels with the abdominal aorta and bilateral iliac arteries. Ensure that there is no blood endoleak at the anastomotic site after the blood flow is restored. If there is no abnormality, wrap the aneurysm capsule wall around the artificial blood vessel and suture it. Suture the posterior peritoneum and close the abdominal incision layer by layer, leaving a drainage tube. Antibiotics were administered postoperatively to prevent infection.