Sakamoto Ichiro, Mori Masakazu, Nishida Akifumi, Fukushima Aya, Sueyoshi Eijun, Hazama Shiro, Eishi Kiyoyuki, Hayashi Kuniaki
Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan.
J Endovasc Ther. 2003 Dec;10(6):1075-81. doi: 10.1177/152660280301000608.
To evaluate the efficacy of embolizing iliac artery aneurysms (IAAs) developing after abdominal aortic aneurysm (AAA) repair.
The records of 6 patients (5 men; mean age 79 years, range 61-87) with unilateral (n=3) or bilateral (n=3) IAAs that had developed after AAA repair were reviewed. In all patients, the limbs of the bifurcated graft were anastomosed end-to-end or end-to-side with the external iliac arteries during AAA repair. Before embolization, superior mesenteric artery (SMA) arteriography was done in all patients to evaluate collateral pathways to the inferior mesenteric artery (IMA).
The unilateral IAAs were treated by proximal and distal embolization. In 2 patients with bilateral IAAs, SMA angiography showed sufficient collateral flow to the IMA, so the aneurysms were treated by proximal embolization and packing. In the other bilateral IAA case, the left 6-cm IAA was treated by proximal and distal embolization, while the contralateral 3-cm IAA was not embolized because angiography demonstrated inadequate collateral flow to the IMA, indicating a possible risk of colon ischemia if both IAAs were embolized. Immediate postprocedural angiography in all patients showed complete exclusion of the IAAs. Mild buttock claudication occurred in 1 patient. There were no episodes of rupture over a mean 46-month follow-up.
Embolization is a safe and effective alternative to open surgery for the treatment of IAAs that develop after AAA repair. However, before embolization, angiographic evaluation of collateral pathways to the IMA is essential to reduce the risk of colon ischemia.
评估栓塞腹主动脉瘤（AAA）修复术后发生的髂动脉瘤（IAA）的疗效。
回顾了6例（5例男性；平均年龄79岁，范围61 - 87岁）AAA修复术后发生单侧（n = 3）或双侧（n = 3）IAA患者的记录。在所有患者中，AAA修复期间，分叉移植物的肢体与髂外动脉进行端端或端侧吻合。在栓塞前，所有患者均进行了肠系膜上动脉（SMA）血管造影，以评估向肠系膜下动脉（IMA）的侧支通路。
单侧IAA采用近端和远端栓塞治疗。在2例双侧IAA患者中，SMA血管造影显示向IMA有足够的侧支血流，因此动脉瘤采用近端栓塞和填塞治疗。在另一例双侧IAA病例中，左侧6 cm的IAA采用近端和远端栓塞治疗，而对侧3 cm的IAA未栓塞，因为血管造影显示向IMA的侧支血流不足，表明如果双侧IAA均栓塞可能有结肠缺血风险。所有患者术后即刻血管造影显示IAA完全被排除。1例患者出现轻度臀部间歇性跛行。在平均46个月的随访中无破裂事件发生。
栓塞是治疗AAA修复术后发生的IAA的一种安全有效的开放手术替代方法。然而，在栓塞前，对IMA侧支通路进行血管造影评估对于降低结肠缺血风险至关重要。
