用于腹主动脉髂动脉瘤修复的髂总动脉和髂内动脉闭塞：使用Amplatzer血管封堵器的经验
Occlusion of the common and internal iliac arteries for aortoiliac aneurysm repair: experience with the Amplatzer vascular plug.
作者信息
Grenon S Marlene, Gagnon Joel, Hsiang York, Sidhu Ravi, Taylor David, Clement Jason, Chen Jerry
机构信息
Division of Vascular Surgery St. Paul's Hospital, University of British Columbia, Vancouver, BC.
出版信息
Can J Surg. 2009 Dec;52(6):E276-80.
BACKGROUND
We sought to evaluate and describe our centre's experience with the Amplatzer vascular plug (AVP) for the occlusion of common and internal iliac arteries (CIA; IIA) during endovascular aortic aneurysm repair (EVAR).
METHODS
We performed a retrospective analysis of 20 consecutive patients between October 2006 and December 2007, who underwent occlusion of the CIA or IIA before or during EVAR to prevent endoleak.
RESULTS
Among these 20 patients, 21 occlusion procedures occurred and 20 were successful. In the only unsuccessful case, the patient had EVAR, but occlusion with an AVP was not possible because of severe narrowing at the origin of the vessel. Of the successfully treated patients, 2 presented with ruptured aneurysms, whereas the others had elective procedures. Eleven patients received aortouni-iliac grafts and femoral-femoral bypass, and 9 patients received a bifurcated stent graft. In 5 patients, the AVP occlusion and EVAR procedures were staged; in these cases occlusion occurred first, followed by EVAR on average 29 (standard deviation [SD] 23) days later. We deployed 7 AVPs in the CIA, whereas 13 were deployed in the IIA. The average diameter of the vessels occluded was 10 (SD 1) mm and the average size of the device used was 13 (SD 1) mm, representing a device diameter 28% (SD 2%) greater than the vessel diameter. We used a single device in 18 patients, whereas 2 devices were deployed in the same artery in 2 patients. Four patients underwent concomitant coil embolization. On follow-up computed tomography (CT) scans, all occlusion procedures were clinically successful. At the 14-month (SD 1 mo) follow-up, 4 patients had a small type-II endoleak unrelated to the occlusion procedure and 1 had a type-I endoleak that required graft limb extension. Four patients had buttock claudication but none had changes in sexual function, ischemic complications or device dislodgement on CT scans.
CONCLUSION
The AVP is a safe and effective method to occlude the CIA and IIA in patients undergoing EVAR.
背景
我们旨在评估并描述我们中心在血管内主动脉瘤修复术（EVAR）期间使用Amplatzer血管塞（AVP）闭塞髂总动脉（CIA）和髂内动脉（IIA）的经验。
方法
我们对2006年10月至2007年12月期间连续20例患者进行了回顾性分析，这些患者在EVAR之前或期间接受了CIA或IIA的闭塞以预防内漏。
结果
在这20例患者中，共进行了21次闭塞手术，20次成功。在唯一一次失败的病例中，患者接受了EVAR，但由于血管起始处严重狭窄，无法使用AVP进行闭塞。在成功治疗的患者中，2例为破裂性动脉瘤，其余为择期手术。11例患者接受了主动脉单髂动脉移植物和股-股旁路手术，9例患者接受了分叉型支架移植物。5例患者的AVP闭塞和EVAR手术分阶段进行；在这些病例中，先进行闭塞，平均29（标准差[SD]23）天后进行EVAR。我们在CIA中部署了7个AVP，在IIA中部署了13个。闭塞血管的平均直径为10（SD 1）mm，所用装置的平均尺寸为13（SD 1）mm，装置直径比血管直径大28%（SD 2%）。18例患者使用了单个装置，2例患者在同一动脉中部署了2个装置。4例患者同时进行了弹簧圈栓塞。在随访计算机断层扫描（CT）中，所有闭塞手术在临床上均成功。在14个月（SD 1个月）的随访中，4例患者出现与闭塞手术无关的小型II型内漏，1例患者出现I型内漏，需要延长移植物肢体。4例患者有臀部跛行，但CT扫描显示性功能、缺血性并发症或装置移位均无变化。
结论
AVP是在接受EVAR的患者中闭塞CIA和IIA的一种安全有效的方法。
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