Bharwani N, Raja J, Choke E, Belli A M, Thompson M M, Morgan R A, Munneke G
Radiology Department, St George's NHS Trust, Blackshaw Road, London, SW17 0QT, UK.
Cardiovasc Intervent Radiol. 2008 May-Jun;31(3):504-8. doi: 10.1007/s00270-007-9260-x. Epub 2008 Jan 23.
Patients who undergo endovascular repair of aorto-iliac aneurysms (EVAR) require internal iliac artery (IIA) embolization (IIAE) to prevent type II endoleaks after extending the endografts into the external iliac artery. However, IIAE may not be possible in some patients due to technical factors or adverse anatomy. The aim of this study was to assess retrospectively whether patients with aorto-iliac aneurysms who fail IIAE have an increase in type II endoleak after EVAR compared with similar patients who undergo successful embolization. We retrospectively analyzed the records of 148 patients who underwent EVAR from December 1997 to June 2005. Sixty-one patients had aorto-iliac aneurysms which required IIAE before EVAR. Fifty patients had successful IIAE and 11 patients had unsuccessful IIAE prior to EVAR. The clinical and imaging follow-up was reviewed before and after EVAR. The endoleak rate of the embolized group was compared with that of the group in whom embolization failed. After a mean follow-up of 19.7 months in the study group and 25 months in the control group, there were no statistically significant differences in outcome measures between the two groups. Specifically, there were no type II endoleaks related to the IIA in patients where IIAE had failed. We conclude that failure to embolize the IIA prior to EVAR should not necessarily preclude patients from treatment. In patients where there is difficulty in achieving coil embolization, it is recommended that EVAR should proceed, as clinical sequelae are unlikely.
接受腹主动脉-髂动脉瘤腔内修复术（EVAR）的患者，在将腔内移植物延伸至髂外动脉后，需要进行髂内动脉（IIA）栓塞术（IIAE）以预防II型内漏。然而，由于技术因素或解剖结构不利，部分患者可能无法进行IIAE。本研究的目的是回顾性评估，与成功进行栓塞的类似患者相比，IIAE失败的腹主动脉-髂动脉瘤患者在EVAR后II型内漏是否增加。我们回顾性分析了1997年12月至2005年6月期间接受EVAR的148例患者的记录。61例患者患有腹主动脉-髂动脉瘤，在EVAR前需要进行IIAE。50例患者IIAE成功，11例患者在EVAR前IIAE失败。对EVAR前后的临床和影像学随访进行了回顾。将栓塞组的内漏率与栓塞失败组的内漏率进行比较。研究组平均随访19.7个月，对照组平均随访25个月，两组间的结局指标无统计学显著差异。具体而言，IIAE失败的患者中没有与IIA相关的II型内漏。我们得出结论，EVAR前未能栓塞IIA不一定会使患者无法接受治疗。对于难以实现弹簧圈栓塞的患者，建议进行EVAR，因为临床后遗症不太可能发生。
