破裂孤立性髂动脉瘤血管内修复的中期结果。
Midterm outcome of endovascular repair of ruptured isolated iliac artery aneurysms.
机构信息
Diagnostic and Interventional Radiology, University Hospital, Zürich, Switzerland.
出版信息
J Vasc Surg. 2010 Nov;52(5):1159-63. doi: 10.1016/j.jvs.2010.06.020. Epub 2010 Jul 31.
PURPOSE
This study analyzed the clinical and morphologic outcomes of endovascular treatment of ruptured isolated iliac artery aneurysms (RIIAA) at midterm follow-up.
METHODS
Eleven patients with RIIAA (1 woman, 10 men; mean age, 73 years; mean IIAA diameter, 69.1 mm) were identified in a single-center database of patients who underwent endovascular aortoiliac aneurysm repair between April 2001 and December 2009. Devices inserted included 9 leg endografts in 7 patients (Excluder, n=7; Zenith, n=2), 3 bifurcated stent grafts in 3 patients (Excluder), and 1 aortouniiliac stent graft in 1 patient (Zenith). Endovascular occlusion of the internal iliac artery or its branches was performed in all cases by coils (n=10) or Amplatzer occluder plug (n=1). Immediately after endovascular aneurysm exclusion, a computed tomography (CT) angiography was obtained in nine patients. Except for this adjunct postimplantation CT scanning, the imaging follow-up was the same as for nonruptured aortoiliac aneurysms at 3, 6, and 12 months and annually thereafter.
RESULTS
Mean delay from hospital admission to intervention was 78.5 minutes. Mean intervention time was 150 minutes. The assisted primary technical success rate was 100%. Median lengths of stay were 2 days in the intensive care unit and 13 days in the hospital. Abdominal compartment syndrome developed in three patients who received open abdomen treatment. The 30-day mortality was 18%. The mean follow-up was 23 months (range, 0-69 months). There were no late deaths during the follow-up. There was no need for late surgical conversion. Aneurysm sac shrinkage (defined as >5 mm) was recorded in five patients, whereas the sac diameter remained stable in four. There was no patient with aneurysm sac growth. Additional stent graft insertion as the only secondary intervention for a type Ib leak was performed. Type II endoleaks (primary and secondary) were found in 36% and secondary Ib in 9% of the patients.
CONCLUSION
Emergency stent grafting of RIIAA is feasible and safe with good midterm outcome.
目的
本研究旨在分析血管内治疗破裂孤立髂动脉瘤（RIIAA）的临床和形态学结果，随访时间为中期。
方法
在 2001 年 4 月至 2009 年 12 月期间，对在单中心行腹主动脉瘤腔内修复术的患者数据库中，共发现 11 例 RIIAA 患者（1 名女性，10 名男性；平均年龄 73 岁；平均 IIAA 直径 69.1mm）。置入的器械包括 9 个支腿内漏支架（7 例患者中使用 Excluder，7 例；Zenith，2 例）、3 个分叉式支架移植物（3 例患者中使用 Excluder）和 1 个腹主动脉-髂动脉支架移植物（1 例患者中使用 Zenith）。所有病例均采用弹簧圈（n=10）或 Amplatzer 封堵器塞（n=1）对髂内动脉或其分支进行血管内闭塞。在 9 例患者中，血管内动脉瘤排除后立即进行 CT 血管造影检查。除了这种辅助性植入后 CT 扫描外，非破裂性腹主动脉瘤的影像学随访时间为术后 3、6、12 个月，此后每年一次。
结果
从住院到干预的平均时间延迟为 78.5 分钟。平均手术时间为 150 分钟。主要技术成功率为 100%。中位重症监护病房住院时间为 2 天，住院时间为 13 天。3 名患者接受了开放性腹部治疗，出现腹腔间隔室综合征。30 天死亡率为 18%。平均随访时间为 23 个月（范围，0-69 个月）。随访期间无晚期死亡。无需进行晚期手术转换。5 例患者出现瘤囊缩小（定义为>5mm），4 例患者瘤囊直径稳定。无患者出现瘤囊增大。仅对 1 例 Ib 型漏患者进行了额外的支架移植物置入作为二级干预。36%的患者出现了 II 型内漏（原发性和继发性），9%的患者出现了继发性 Ib 型内漏。
结论
RIIAA 的紧急支架置入是可行和安全的，中期结果良好。
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