主动脉疾病专题研究(Monographic Study of Aortic Diseases)

腹主动脉瘤腔内修复术中髂动脉瘤的处理策略

Published at: 2015年第24卷第6期

葛红卫 1 , 朱云峰 1 , 朱永斌 1 , 吴元兵 1 , 姜云飞 1 , 黄一鸣 1 , 陈诚 1
1 苏州大学附属第三医院 血管外科,江苏 常州 213003
通讯作者 红卫 葛 Email: ghw75@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.06.004
基金:

摘要

目的:探讨腹主动脉瘤合并髂动脉瘤的腔内修复术(EVAR)方法。方法:回顾性分析2007 年8 月—2014 年3 月35 例腹主动脉瘤合并髂动脉瘤行EVAR 术患者资料,其中9 例合并单侧髂内动脉瘤,1 例合并双侧髂内动脉瘤,14 例合并单侧髂总动脉瘤(直径>18 mm),11 例合并双侧髂总动脉瘤,所用腔内技术包括栓塞髂内动脉瘤后覆盖,髂内动脉瘤单纯覆盖,“喇叭口”支架,以及“三明治”技术重建一侧髂内动脉等。结果:所有腔内技术均获得成功,手术时间(125±40)min,出血量(173±65)mL。术中发现内漏8 例(22.9%),其中I 型内漏4 例(近端2 例,远端2 例)均经球囊扩张后内漏消失,III 型内漏1 例,经扩张及部分加弹簧圈栓塞后内漏消失,II 型内漏2 例及IV 型内漏1 例,均未予处理。35 例术后随访6~60 个月,无动脉瘤破裂,2 例术后6 个月发现腹主动脉瘤体增大,造影确诊远端I 型内漏,经弹簧圈栓塞后内漏消失,其余33 例瘤体直径无增大。结论:对于合并髂动脉瘤的腹主动脉瘤患者,有效处理髂内动脉,然后根据髂总动脉直径选择合适的治疗方法可以达到理想的近期效果。


Treatment strategy of iliac artery aneurysm in endovascular repair for abdominal aortic aneurysm

Abstract

Objective: To investigate the method of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) combined with iliac artery aneurysm. Methods: The clinical data of 35 patients with AAA and concomitant iliac artery aneurysm undergoing EVAR from August 2007 to March 2014 were retrospectively analyzed. The patients consisted of 9 cases complicated with unilateral internal iliac artery aneurysm, one case with bilateral internal iliac artery aneurysm, 14 cases with unilateral common iliac artery aneurysm (diameter larger than 18 mm) and 11 cases with bilateral common iliac artery aneurysm. The endovascular procedures performed included internal iliac artery embolization followed with stent coverage, simple stent coverage of the internal iliac artery aneurysm, use of a braided stent, and Sandwich technique for internal iliac artery endorevascularization. Results: All endovascular procedures were successfully performed, with an average operative time of (125± 40) min and blood loss of (173±65) mL. Intraoperative endoleak was observed in 8 patients (22.9%), including type I endoleak in 4 cases (2 from the proximal and 2 from the distal attachment site) which were all resolved after balloon dilatation, type III endoleak in one case which was resolved by dilatation plus adjunctive coil embolization, type II endoleak in 2 cases and type IV endoleak in one case, none of which received further intervention. Postoperative follow-up was conducted for 6 to 26 months in the 35 patients, during which time no aneurysmal rupture occurred; AAA enlargement was found in 2 cases 6 months after procedure, which was identified as distal type I endoleak by radiography and resolved by coil embolization, and no aneurysmal enlargement occurred in any of the remaining 33 cases. Conclusion: Ideal short-term results may be obtained in patients with AAA and concomitant iliac artery aneurysm by appropriate treatment of the internal iliac artery and then suitable endovascular techniques according to the diameter of the common iliac artery.


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引用本文: 红卫 葛, 云峰 朱, 永斌 朱, 元兵 吴, 云飞 姜, 一鸣 黄, 诚 陈. 腹主动脉瘤腔内修复术中髂动脉瘤的处理策略[J]. 中国普通外科杂志, 2015, 24(6): 787-791.
Cite this article as: GE Hongwei, ZHU Yunfeng, ZHU Yongbin, WU Yuanbing, JIANG Yunfei, HUANG Yiming, CHEN Cheng . Treatment strategy of iliac artery aneurysm in endovascular repair for abdominal aortic aneurysm[J]. Chin J Gen Surg, 2015, 24(6): 787-791.