Kritpracha Boonprasit, Pigott John P, Price Charles I, Russell Todd E, Corbey Mary Jo, Beebe Hugh G
Jobst Vascular Center, Toledo, Ohio 43606, USA.
J Vasc Surg. 2003 May;37(5):943-8. doi: 10.1067/mva.2003.251.
Internal iliac artery (IIA) coil embolization as an adjunct to endovascular stent grafting (ESG) is common practice for treating abdominal aortic aneurysm (AAA) in patients with a substantially enlarged common iliac artery requiring extension of the stent-graft limb into the external iliac artery. The literature describing pelvic ischemia in association with IIA coil embolization contains conflicting reports of symptom severity. We studied IIA occlusion outcome as a function of coil placement in the IIA.
From August 1997 to March 2002, 20 patients with AAA underwent ESG with unilateral IIA coil embolization. Coils were placed proximal to the first branch of the IIA in 8 patients and distal to the first branch in 12 patients. Symptoms of pelvic ischemia and mid-term outcome were studied.
Patients included 18 men and 2 women with mean age of 70(1/2) years (range, 53-86 years). Mean diameter of AAA was 54.4 mm (range, 38-80 mm), and of common iliac artery was 24.2 mm (range, 15-48 mm). Ten patients (50%) had new onset of symptoms of pelvic ischemia after endograft procedures: 1 of 8 patients (13%) with proximal IIA embolization had buttock claudication, and 9 of 12 patients (75%) with distal IIA embolization had pelvic ischemic symptoms, including buttock claudication in 8 and impotence in 1 (P =.02, Fisher exact test). No colonic ischemia occurred in this series. At 12-month follow-up, 4 patients with distal IIA embolization were symptom-free. At further follow-up to 24 months, 4 patients remained significantly limited with symptoms of claudication.
A significantly higher incidence of symptoms of pelvic ischemia occurred with more distal placement of coils for IIA embolization. Failure to control for extent of coil placement may account for the apparently conflicting results in published studies. IIA coil embolization should be performed as proximal as possible to prevent interference with pelvic collateral circulation.
对于腹主动脉瘤（AAA）患者，当其髂总动脉显著增粗，需要将支架移植物肢体延伸至髂外动脉时，髂内动脉（IIA）线圈栓塞作为血管内支架植入术（ESG）的辅助手段是一种常用的治疗方法。关于与IIA线圈栓塞相关的盆腔缺血的文献，对症状严重程度的报道相互矛盾。我们研究了IIA闭塞结果与IIA中线圈放置的关系。
1997年8月至2002年3月，20例AAA患者接受了ESG联合单侧IIA线圈栓塞治疗。8例患者的线圈放置在IIA第一分支近端，12例患者的线圈放置在第一分支远端。研究盆腔缺血症状和中期结果。
患者包括18名男性和2名女性，平均年龄70（1/2）岁（范围53 - 86岁）。AAA的平均直径为54.4mm（范围38 - 80mm），髂总动脉的平均直径为24.2mm（范围15 - 48mm）。10例患者（50%）在植入血管内移植物手术后出现新的盆腔缺血症状：8例近端IIA栓塞患者中有1例（13%）出现臀部间歇性跛行，12例远端IIA栓塞患者中有9例（75%）出现盆腔缺血症状，包括8例臀部间歇性跛行和1例阳痿（P = 0.02，Fisher精确检验）。本系列中未发生结肠缺血。在12个月的随访中，4例远端IIA栓塞患者无症状。在进一步随访至24个月时，4例患者仍因间歇性跛行症状而明显受限。
IIA栓塞时线圈放置越靠近远端，盆腔缺血症状的发生率显著越高。未能控制线圈放置范围可能是已发表研究中结果明显相互矛盾的原因。IIA线圈栓塞应尽可能靠近近端进行以防止干扰盆腔侧支循环。
