血管腔內主動脈瘤修復手術（EVAR）的護理

Nursing Care of Endovascular Aneurysm Repair Patients

主動脈疾病的治療，在過去多是以傳統手術方式、將病灶處切除後進行人工血管置換；近年來、血管腔內主動脈瘤修復（endovascular aneurysm repair, EVAR）手術發展，即是在主動脈內使用外嵌有金屬支架（stent-graft）的人工血管，如同在膨大血管前後，架接一段隧道讓血流通過，避免血流持續衝擊已膨大且變薄之血管內壁，導致破裂風險。血管腔內主動脈瘤修復手術在納入健保給付後，由於安全、恢復快等諸多優點，除了提供年齡較大、有心肺衰竭、或多重器官疾病高風險患者，比較安全的治療方式，近年來也有逐漸取代傳統手術，成為治療主動脈疾病時優先選擇的趨勢。本文就血管腔內主動脈瘤修復手術的發展、適應症、禁忌、及術後常見之護理問題和處置深入探討，期能提供臨床護理人員了解主動脈支架照護的相關議題，提升護理專業上的照護品質。

The treatment of aortic disease previously used conventional open surgery to replace the aorta with artificial vascular prosthesis after resecting the lesioned segment. The recently developed technique of endovascular aneurysm repair (EVAR) uses a stent graft to reinforce the diseased aortic wall while allowing blood flow continuity and preventing further aortic expansion, dissection and aortic rupture. Taiwan's National Health Insurance now covers payment for authorized EVAR procedures, making treatments safer for patients who are elderly, have congestive heart failure, have multiple comorbidities, or have other high-risk factors. EVAR is gradually replacing previous methods to become the primary treatment approach for aortic disease. This article discusses the development of EVAR, indications, operative procedures, complications, postoperative risk factors, and clinical nursing problems. We hope that this article provides new information on nursing care for patients undergoing endovascular aneurysm repair surgery.