Hakaim Albert G, Lau L Louis, Neuhauser Beate, Klocker Josef, Oldenburg W Andrew, McKinney J Mark, Paz-Fumigalli Ricardo, Stockland Andrew
Section of Vascular Surgery, Mayo Clinic, Jacksonville, FL, USA.
Vasc Endovascular Surg. 2004 Jan-Feb;38(1):51-6. doi: 10.1177/153857440403800106.
Stent-grafts are ideally terminated within the common iliac artery (CIA). However, CIA ectasia may require hypogastric artery occlusion, with stent-graft extension to the external iliac artery. Alternatively, the diameter of the distal stent-graft may be increased, or flared, to allow exclusion of the abdominal aortic aneurysm. This report details the authors' experience with this technique. Forty-one patients received bifurcated stent-grafts (BSG): 20 received an AneuRx device, and 21 received a Zenith device. CIA ectasia (diameter 15-25 mm) was treated with a distal flare of 2-4 mm greater than the CIA diameter. Patients were followed up with computed tomography scan at 1, 6, and 12 months. Statistical analysis was performed using ANOVA within groups and unpaired two-tailed t test between groups. A p value of < 0.05 was considered significant. Eight of 20 patients (40%) (11 CIA) received an AneuRx device and 13/21 (62%) (17 CIA) received a Zenith device, with a distal flare. Values are (n) mean (mm) +/- SE. There were no deaths, endoleaks, migrations, or conversions to open repair. Follow-up mean was 24.7 and 20.6 (range 15-28) months for AneuRx and Zenith groups, respectively. In comparing initial and 12-month CIA diameters, AneuRx grafts 20 +/-0.8 vs 21.5 +/-1.0 were not significantly different, p = 0.2, nor was the same comparison for Zenith, 17 +/-0.5 vs 19.1 +/-0.4, significant, p = 0.57. At a mean follow-up of 12 months, distal flare of iliac limbs with either AneuRx or Zenith devices affords a seal for CIA ectasia and/or aneurysms complicating EVAR.
覆膜支架理想情况下应在髂总动脉（CIA）内终止。然而，髂总动脉扩张可能需要闭塞髂内动脉，将覆膜支架延伸至髂外动脉。或者，可以增加或扩张远端覆膜支架的直径，以实现腹主动脉瘤的隔绝。本报告详细介绍了作者使用该技术的经验。41例患者接受了分叉覆膜支架（BSG）：20例接受了AneuRx装置，21例接受了Zenith装置。髂总动脉扩张（直径15 - 25毫米）采用比髂总动脉直径大2 - 4毫米的远端扩张进行治疗。患者在1个月、6个月和12个月时接受计算机断层扫描随访。使用组内方差分析和组间非配对双尾t检验进行统计分析。p值<0.05被认为具有统计学意义。20例患者中的8例（40%）（11条髂总动脉）接受了AneuRx装置，21例中的13例（62%）（17条髂总动脉）接受了带有远端扩张的Zenith装置。数值为（n）平均值（毫米）±标准误。无死亡、内漏、移位或转为开放修复的情况。AneuRx组和Zenith组的随访平均时间分别为24.7个月和20.6个月（范围15 - 28个月）。比较初始和12个月时的髂总动脉直径，AneuRx移植物分别为20±0.8与21.5±1.0，差异无统计学意义，p = 0.2，Zenith装置的相同比较，17±0.5与19.1±0.4，差异也无统计学意义，p = 0.57。在平均12个月的随访中，使用AneuRx或Zenith装置的髂支远端扩张可为髂总动脉扩张和/或与腔内修复术相关的动脉瘤提供封闭。
