Serviço Integrado de Técnicas Endovasculares (SITE-Endovascular Techniques Integrated Service), Rio de Janeiro, Brazil.
J Vasc Surg. 2010 Mar;51(3):545-50; discussion 550. doi: 10.1016/j.jvs.2009.09.027.
This study presents technical aspects and initial results with iliac bifurcated devices (IBDs).
Since 2006, 47 IBDs were scheduled for 37 patients who were followed up between 2 and 31 months. Iliac aneurysms were unilateral in 27 patients and bilateral in 10. Two patients with bilateral common iliac artery aneurysms (CIAAs) did not have a simultaneous aortic aneurysm. Two patients underwent combined thoracoabdominal aneurysm treatment with branched stent grafts, and one underwent combined juxtarenal aneurysm repair with a fenestrated device. The helical iliac side branch device was used in 11 CIAA (23.4%), and the Zenith bifurcated iliac side branch device was used in the remaining 36 (76.6%).
The technical success rate was 97.3% within the 47 intended-to-treat CIAAs (failure to introduce the delivery system in one case, converted to femorofemoral bypass). During follow-up, five (10.6%) hypogastric branch occlusions occurred in five patients. Two patients with bilateral repair had unilateral internal iliac artery side branch occlusions without ischemic symptoms. In contrast, of the three patients with unilateral side branch occlusion and simultaneous contralateral internal iliac artery occlusion (2 chronic and 1 coil embolization), persistent buttock claudication and sexual dysfunction developed in one. The secondary patency, including one redo case, was 87.3% at 22 months (standard error <10%).
The use of branched stent grafts is a feasible procedure, including for patients with bilateral iliac aneurysmal disease or concomitant juxtarenal or thoracoabdominal aortic disease.
本研究介绍了分叉型髂动脉瘤覆膜支架（iliac bifurcated devices，IBDs）的技术要点和初步结果。
自 2006 年以来，我们为 37 例患者计划了 47 例分叉型髂动脉瘤覆膜支架治疗，这些患者的随访时间为 2 至 31 个月。27 例患者为单侧髂动脉瘤，10 例为双侧髂动脉瘤。2 例双侧髂总动脉瘤（common iliac artery aneurysms，CIAAs）患者没有同时合并主动脉瘤，2 例患者接受了分叉型支架移植物联合胸腹主动脉瘤治疗，1 例接受了开窗支架联合肾下型动脉瘤修复。11 例（23.4%）髂总动脉瘤采用螺旋型髂内分支支架，36 例（76.6%）采用泽尼斯分叉型髂内分支支架。
在 47 例计划治疗的 CIAAs 中，技术成功率为 97.3%（1 例因输送系统无法到位而失败，改行股-股旁路）。在随访期间，5 例（10.6%）患者发生 5 例髂内分支闭塞。2 例双侧修复患者出现单侧髂内动脉分支闭塞，无缺血症状。相比之下，3 例单侧分支闭塞且对侧髂内动脉同时闭塞的患者（2 例慢性闭塞，1 例线圈栓塞）中，1 例出现持续性臀部跛行和性功能障碍。包括 1 例再次治疗的患者，22 个月时的二期通畅率为 87.3%（标准误差<10%）。
分叉型支架移植物的应用是一种可行的方法，包括用于双侧髂动脉瘤疾病或合并肾下或胸腹主动脉疾病的患者。
