Caronno Roberto, Piffaretti Gabriele, Tozzi Matteo, Lomazzi Chiara, Rivolta Nicola, Laganà Domenico, Carrafiello Gianpaolo, Recaldini Chiara, Castelli Patrizio
Division of Vascular Surgery, Department of Surgery, University of Insubria, Varese, Italy.
Ann Vasc Surg. 2006 Jul;20(4):496-501. doi: 10.1007/s10016-006-9081-4. Epub 2006 May 31.
We report our experience of endovascular repair of isolated iliac artery aneurysms using commercially available stent grafts (SGs). Twenty-five patients (mean age 71 +/- 7 years) presented with 33 isolated iliac artery aneurysms (common iliac artery n = 29, external iliac artery n = 4). Five patients were symptomatic. Depending on the proximal iliac neck and the presence of unilateral or bilateral iliac artery aneurysms, the patient was treated by tube or bifurcated SG that was delivered percutaneously (n = 14) or through surgical exposure of one femoral artery (n = 12). In our follow-up control protocol, the patients are routinely scheduled after 1, 4, and 12 months and then annually after the intervention. Primary technical success with an instant exclusion of the aneurysm was achieved in all patients. The perioperative (<30 days) mortality rate was 0. Major complications did not occur. Mean hospitalization was 6 +/- 6 days (range 2-28, median 4). Four patients (16%) died during follow-up. At a mean follow-up of 32 months (range 3-72, median 36), we detected three type 1 endoleaks (14.3%) that were managed with additional SG; two stenoses at the distal extremity of the SGs, treated with mechanical thrombectomy; and additional stent. In the remaining patients (n = 17), computed tomography angiography confirmed the patency of the SG and the absence of device complication (e.g., endoleak, migration, breakage); shrinkage of the aneurysm was observed in 11 cases (52.4%). Overall, survival rates at 1, 4, and 5 years were 91.6%, 73.3%, and 58.6%, respectively; event-free rates at 1 and 3 years were 79.4% and 67.4%, respectively. In our experience, SG treatment for isolated iliac artery aneurysm proved to be a feasible and low-risk procedure with acceptable mid-term results. At our institute, it is the primary alternative to conventional surgical repair and is offered as first-line treatment.
我们报告了使用市售支架型人工血管（SG）对孤立性髂动脉瘤进行血管腔内修复的经验。25例患者（平均年龄71±7岁）共存在33个孤立性髂动脉瘤（髂总动脉29个，髂外动脉4个）。5例患者有症状。根据髂动脉近端颈部情况以及单侧或双侧髂动脉瘤的存在情况，患者接受了经皮植入的直管型或分叉型SG治疗（n = 14），或通过手术暴露一侧股动脉植入（n = 12）。在我们的随访控制方案中，患者在干预后1、4和12个月进行常规安排，之后每年随访。所有患者均实现了即刻排除动脉瘤的主要技术成功。围手术期（<30天）死亡率为0。未发生重大并发症。平均住院时间为6±6天（范围2 - 28天，中位数4天）。4例患者（16%）在随访期间死亡。平均随访32个月（范围3 - 72个月，中位数36个月）时，我们检测到3例I型内漏（14.3%），通过额外植入SG进行处理；SG远端出现2处狭窄，采用机械血栓切除术和额外植入支架进行治疗。其余患者（n = 17）中，计算机断层血管造影证实SG通畅且无器械并发症（如内漏、移位、断裂）；11例（52.4%）观察到动脉瘤缩小。总体而言，1年、4年和5年生存率分别为91.6%、73.3%和58.6%；1年和3年无事件发生率分别为79.4%和67.4%。根据我们的经验，SG治疗孤立性髂动脉瘤是一种可行且低风险的手术，中期结果可接受。在我们研究所，它是传统手术修复的主要替代方法，并作为一线治疗方案。
