Patel Niyant V, Long Graham W, Cheema Zulfiqar F, Rimar Kalen, Brown O William, Shanley Charles J
Division of Vascular Surgery, Department of Surgery, William Beaumont Hospital, Royal Oak, Mich. 48073, USA.
J Vasc Surg. 2009 May;49(5):1147-53. doi: 10.1016/j.jvs.2008.11.101. Epub 2009 Feb 23.
To examine contemporary operative techniques and outcomes for repair of isolated iliac artery aneurysms.
We retrospectively reviewed the charts of all patients who underwent repair of an isolated iliac artery aneurysm from February 1995 to June 2007. Mycotic aneurysms and patients with concurrent infrarenal abdominal aortic aneurysms greater than 3.5 cm in diameter were excluded from analysis. Patients with prior abdominal aortic aneurysm repair were not excluded.
Fifty-six patients (96% male; mean age, 72 +/- 10 years) had either open (n = 24) or endovascular (n = 32) repair with median follow-up of 36 months. Seven patients were treated for rupture, six with open repair, and one with an endograft. Average aneurysm size for patients in the open and endovascular repair cohorts was 4.5 +/- 2.4 cm and 4.0 +/- 1.1 cm, respectively (P = .35). One episode of endograft limb thrombosis at five months was treated with catheter-directed thrombolytic therapy and stent placement. Thirty-day mortality for patients undergoing elective and emergent open repair was 1/18 (6%) and 1/6 (17%), respectively. There was no 30-day mortality for the endovascular group. Median length of stay was 10.5 days in the open group and one day in the endovascular elective group (P < .01). There was no mid-term aneurysm-related mortality in either group. Primary patency rates were similar between the open and endovascular groups at five years (100% vs. 96%, P = .07). Aneurysm sac diameter decreased in 67% (21/28) of patients that underwent endovascular repair. One patient with a Type III endoleak required relining of the endograft with a second endograft at 72 months.
These data demonstrate that in appropriately selected patients, endovascular repair of isolated iliac artery aneurysms is a safe, effective alternative to open repair with mid-term follow-up. Endovascular repair is associated with a significantly reduced hospital length of stay and may be associated with decreased need for transfusion and mortality when compared with open repair.
探讨孤立性髂动脉瘤修复的当代手术技术及疗效。
我们回顾性分析了1995年2月至2007年6月期间所有接受孤立性髂动脉瘤修复的患者病历。真菌性动脉瘤以及同时患有直径大于3.5 cm的肾下腹主动脉瘤的患者被排除在分析之外。既往接受过腹主动脉瘤修复的患者未被排除。
56例患者（96%为男性；平均年龄72±10岁）接受了开放手术（n = 24）或血管腔内修复（n = 32），中位随访时间为36个月。7例患者因动脉瘤破裂接受治疗，6例接受开放修复，1例接受腔内修复。开放修复组和血管腔内修复组患者的平均动脉瘤大小分别为4.5±2.4 cm和4.0±1.1 cm（P = 0.35）。1例患者在术后5个月出现腔内修复肢体血栓形成，接受了导管定向溶栓治疗及支架置入术。择期和急诊开放修复患者的30天死亡率分别为1/18（6%）和1/6（17%）。血管腔内修复组无30天死亡病例。开放组的中位住院时间为10.5天，血管腔内修复择期组为1天（P < 0.01）。两组均无中期动脉瘤相关死亡病例。开放组和血管腔内修复组5年的原发性通畅率相似（100%对96%，P = 0.07）。67%（21/28）接受血管腔内修复的患者动脉瘤囊直径缩小。1例Ⅲ型内漏患者在72个月时需要用第二个腔内修复装置对腔内修复装置进行内衬。
这些数据表明，在适当选择的患者中，孤立性髂动脉瘤的血管腔内修复是一种安全、有效的替代开放修复的方法，具有中期随访结果。与开放修复相比，血管腔内修复可显著缩短住院时间，可能减少输血需求和死亡率。
