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目的:评估主动脉腔内修复术（EVRA）治疗复杂近端瘤颈肾下腹主动脉瘤（AAA）的中期疗效。方法:收集2013年6月至2016年6月于天津医科大学总医院血管外科行EVAR的175例肾下AAA患者的资料。根据瘤颈解剖情况将患者分为复杂组与非复杂组，回顾性分析两组术中器械释放成功率、手术成功率、围术期和随访期并发症发生率等指标。结果:复杂组84例，非复杂组91例，两组在性别、年龄、合并疾病及破裂AAA比例方面比较，差异无统计学意义（n P均>0.05）。复杂组与非复杂组在瘤颈长度、瘤体直径和远端解剖因素复杂性方面，差异均有统计学意义（n P均0.05）。复杂组与非复杂组在术中近端瘤颈相关并发症发生率（4.8%比0%）和围术期死亡率（0%比2.2%）方面，差异均无统计学意义（n P均>0.05）。175例患者均获得随访，随访时间为（52±10.3）个月，1例患者随访2个月时死于心肌梗死。复杂组与非复杂组在新发近端瘤颈相关并发症发生率（3.6%比0%）和二次手术干预率方面（15.5%比9.9%），差异均无统计学意义（n P均>0.05）。n 结论:EVAR[包括烟囱技术腹主动脉瘤腔内修复术（chEVAR）、开窗腹主动脉瘤腔内修复术（fEVAR）]治疗解剖条件适宜的复杂近端瘤颈肾下AAA中期疗效良好。fEVAR是拓展短近端锚定区的良好方法，但在瘤颈扭曲、急诊瘤体破裂的情况下，chEVAR仍具有重要作用；对接技术可用于粗瘤颈AAA。“,”Objective:To evaluate the mid-term result of endovascular aortic repair (EVRA) for infrarenal abdominal aortic aneurysm (AAA) with complex proximal neck.Methods:Data of 175 patients with infrarenal AAA who underwent EVAR were collected in Department of Vascular Surgery, Tianjin Medical University General Hospital from June 2013 to June 2016. According to the anatomy of proximal neck, patients were divided into complex group and non-complex group. Technique success rate, surgical success rate, and perioperative and follow-up complications rates of the two groups were retrospectively analyzed.Results:There were 84 cases in the complex group and 91 cases in the non-complex group. No significant differences in age, gender, co-morbidity and proportion of ruptured AAA were found between two groups(all n P>0.05). When compared with non-complex group, the complex group had shorter neck length, larger aneurysmal diameter and more complicated distal anatomic factors (alln P0.05, respectively). The proximal neck-related complications in complex group (3 cases of type Ⅰa endoleak, 1 case of conversion to open surgery) was no significant difference compared with non-complex group (4.8%n vs 0%, n P=0.051). There was no intraoperative death in both groups. No significant difference was found in perioperative mortality between non-complex group and complex group (2.2% n vs 0%, n P=0.498). No new proximal neck-related complications occurred in both groups during the perioperative period. All cases were followed up for (52±10.3) months, and one case died of myocardial infarction at two-month follow-up. There was no significant difference in new proximal neck-related complications rate between complex group (2 cases of type Ⅰa endoleak and 1 case of pseudoaneurysm at the proximal end of the stent) and non-complex group (3.6% n vs 0%, n P=0.263). No significant difference was found in reintervention rate between complex group and non-complex group (3.6% n vs 9.9%, n P=0.265).n Conclusions:EVAR (including chEVAR, fEVAR) can obtain good mid-term efficacy for suitable infrarenal AAA with complex proximal neck. fEVAR is a better method to extend proximal landing zone, while chEVAR still plays an important role for AAA with severe tortuosity or under emergent rupture.Docking technique is suitable for AAA with diameter of proximal neck more than 28 mm.