Ziegler Peter, Avgerinos Efthimios D, Umscheid Thomas, Perdikides Theodossios, Erz Kerstin, Stelter Wolf J
Städtische Kliniken, Frankfurt a.M. Höchst, Frankfurt, Germany.
J Vasc Surg. 2007 Aug;46(2):204-10. doi: 10.1016/j.jvs.2007.04.015. Epub 2007 Jun 27.
The objective of the current study was to share a 6-year experience with the iliac bifurcation device (IBD) and determine its safety and effectiveness in patients with common iliac artery aneurysms.
Between 2001 and 2006, 46 patients were prospectively enrolled in a single institution study on the IBD. Indications included unilateral or bilateral common iliac artery aneurysms (CIAA) (combined or not with abdominal aortic aneurysm endovascular repair). The first 26 patients were intended to receive a first generation unibody IBD and the following 20 patients the second generation, modular, IBD.
In 33 patients out of 46 attempted (technical success per patient 72%), 35 iliac bifurcated devices (2 patients received bilateral IBD) out of 51 attempted (technical success per vessel 69%), were successfully implanted. The technical success rate (per vessel) was 58% for the first generation device and 85% for the second generation device. Inability to introduce the side branch into the IIA and intraoperative occlusions were the main reasons for technical failure. Among these failures, only two patients required open conversions. The mean +/- SD follow-up (radiological and clinical) of the 33 patients with a total of 35 successful IBD implantations was 26 +/- 17 months (median 24, range 3 to 60). During the follow-up period out of 35 successfully-implanted iliac bifurcation devices, four (11%) hypogastric side branch occlusions occurred, all within the first 12 months. Cumulative IBD side branch patency was 87% at 60 months. Comparing the first with the second generation IBD outcomes, cumulative patency rates at 2 years revealed no statistical difference (P = .774). No endoleak, and particularly no IBD, modular side branch disconnection, no late rupture, or deaths have yet been encountered.
Preservation of pelvic circulation in high risk patients treated for bilateral or unilateral common iliac aneurysms combined or without AAA is feasible and secure exclusively by endovascular repair. New generation iliac bifurcated devices show a favourable intraoperative performance and long-term outcomes.
本研究的目的是分享使用髂动脉分叉装置（IBD）6年的经验，并确定其在髂总动脉瘤患者中的安全性和有效性。
2001年至2006年期间，46例患者前瞻性纳入一项关于IBD的单机构研究。适应证包括单侧或双侧髂总动脉瘤（CIAA）（合并或不合并腹主动脉瘤血管内修复）。前26例患者打算接受第一代一体式IBD，随后20例患者接受第二代模块化IBD。
46例尝试治疗的患者中有33例（每位患者的技术成功率为72%），51例尝试植入的髂动脉分叉装置中有35例（2例患者接受双侧IBD）（每个血管的技术成功率为69%）成功植入。第一代装置的技术成功率（每个血管）为58%，第二代装置为85%。无法将侧支引入髂内动脉（IIA）和术中闭塞是技术失败的主要原因。在这些失败病例中，只有2例患者需要转为开放手术。33例成功植入35个IBD的患者的平均±标准差随访（影像学和临床）时间为26±17个月（中位数24个月，范围3至60个月）。在随访期间，35个成功植入的髂动脉分叉装置中，有4个（11%）出现了髂内动脉侧支闭塞，均发生在最初12个月内。60个月时IBD侧支的累积通畅率为87%。比较第一代和第二代IBD的结果，2年时的累积通畅率无统计学差异（P = 0.774）。尚未发现内漏，特别是没有IBD模块化侧支断开、晚期破裂或死亡情况。
对于双侧或单侧髂总动脉瘤合并或不合并腹主动脉瘤的高危患者，仅通过血管内修复来保留盆腔循环是可行且安全的。新一代髂动脉分叉装置在术中表现良好且具有长期疗效。
