Bergamini Thomas M, Rachel Elizabeth S, Kinney Edward V, Jung Matthew T, Kaebnick Hermann W, Mitchell Richard A
Surgical Care Associates, 4003 Kresge Way, Louisville, KY 40207, USA.
J Vasc Surg. 2002 Jan;35(1):120-4. doi: 10.1067/mva.2002.120038.
To describe four patients with abdominal aortic aneurysm and bilateral common iliac artery aneurysms repaired by coil embolization of the ipsilateral internal iliac artery, aortouniiliac endograft extended to the ipsilateral external iliac artery, femorofemoral bypass grafting, and a contralateral external iliac to internal iliac stent graft to preserve pelvic perfusion.
Four patients with multiple risk factors, abdominal aortic aneurysm (mean diameter, 6.6 cm), and bilateral common iliac artery aneurysms were evaluated with contrast-enhanced computed tomography scanning, arteriography, and intravascular ultrasonography. Aortobiiliac endovascular abdominal aortic aneurysm repair was not feasible because of extension of the common iliac artery aneurysms to the iliac bifurcation bilaterally.
The abdominal aortic aneurysms were repaired with an aortouniiliac endograft. The ipsilateral common iliac artery aneurysms were treated by coil embolization of the internal iliac artery and extension of the endograft to the external iliac artery. The contralateral common iliac artery aneurysms were excluded by a custom-made stent graft (n = 2) or a commercial stent graft (n = 2) from the external iliac artery to the internal iliac artery, which preserved pelvic inflow via retrograde perfusion from the femorofemoral bypass. Mean length of stay was 3.5 days. One patient had hip claudication. Follow-up (mean 10 months, range 6 to 17) demonstrated exclusion of the abdominal aortic aneurysm and common iliac artery aneurysms with no endoleak and patent external iliac artery-to-internal iliac artery endografts in all patients.
Patients with bilateral common iliac artery aneurysms that extend to the iliac bifurcation may be excluded from endovascular abdominal aortic aneurysm repair because of concerns regarding pelvic ischemia after occlusion of both internal iliac arteries. External iliac artery-to-internal iliac artery endografting is a feasible alternative to maintain pelvic perfusion and still allow endograft repair of the abdominal aortic aneurysm in these patients.
描述4例腹主动脉瘤合并双侧髂总动脉瘤患者，通过同侧髂内动脉弹簧圈栓塞、主动脉单髂动脉移植物延伸至同侧髂外动脉、股-股旁路移植术以及对侧髂外动脉至髂内动脉支架移植物来保留盆腔灌注，从而进行修复的情况。
对4例有多种危险因素、腹主动脉瘤（平均直径6.6 cm）及双侧髂总动脉瘤的患者进行了增强计算机断层扫描、血管造影及血管内超声检查。由于双侧髂总动脉瘤延伸至髂总动脉分叉处，因此，双侧髂内动脉闭塞后，主动脉双髂动脉腔内修复腹主动脉瘤不可行。
腹主动脉瘤采用主动脉单髂动脉移植物修复。同侧髂总动脉瘤通过髂内动脉弹簧圈栓塞及移植物延伸至髂外动脉进行治疗。对侧髂总动脉瘤采用定制的支架移植物（n = 2）或商用支架移植物（n = 2）从髂外动脉至髂内动脉进行封堵，通过股-股旁路逆行灌注保留盆腔血流。平均住院时间为3.5天。1例患者出现臀部间歇性跛行。随访（平均10个月，范围6至17个月）显示，所有患者的腹主动脉瘤和髂总动脉瘤均被封堵，无内漏，髂外动脉至髂内动脉支架移植物通畅。
双侧髂总动脉瘤延伸至髂总动脉分叉处的患者，因担心双侧髂内动脉闭塞后盆腔缺血，可能无法接受血管腔内腹主动脉瘤修复。髂外动脉至髂内动脉支架移植术是一种可行的替代方法，可维持盆腔灌注，同时仍允许对这些患者进行腹主动脉瘤的腔内修复。
