Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania Health System, Philadelphia, PA, USA.
J Vasc Surg. 2011 Feb;53(2):269-73. doi: 10.1016/j.jvs.2010.08.062. Epub 2010 Oct 27.
The purpose of this study was to examine the fate of aneurysmal iliac arteries managed during endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA).
We analyzed data from the Cook Zenith trial. Follow-up was at 1 month, 6 months, 12 months, and then annually for 5 years. Patients were evaluated according to the largest iliac artery diameter: group A (≥ 20 mm) and group B (< 20 mm). These groups were further subdivided based on iliac artery growth ≥ 5 mm during follow-up. The Fisher exact test and χ(2) test were used.
Of 736 patients treated, 671 had a follow-up examination (group A = 274). In group A, 220 (80%) were treated with flared limbs in the common iliac artery. Group A did not demonstrate increased iliac growth as compared to group B. Furthermore, both groups had a similar percentage of patients that experienced iliac artery expansion of 32.1% and 31.5%, respectively. Extension to the external iliac artery did not affect growth (P = .4). No difference was noted in the need for secondary interventions between groups. However, group A patients that did not experience growth were more likely to develop a distal type I endoleak than group B patients who did not develop growth (P = .03). There was no difference in serious adverse events (SAEs) between groups (P = .51). However, patients that developed iliac artery growth in either group were less likely to have an SAE compared to patients who did not experience growth (P = .035). There was no difference in the mean percent oversizing of the iliac limbs between groups A and B. However, the mean percent oversizing in groups A and B that had iliac artery growth was significantly higher than in those that demonstrated no growth (P < .01).
Aneurysmal iliac arteries managed by flared limbs or external iliac extensions at the time of EVAR for AAA do not demonstrate future iliac growth, increased rate of secondary interventions, or SAEs compared to patients with normal iliac arteries. This suggests that aneurysmal iliac arteries can be safely treated with appropriately sized limbs landed in the common or external iliac artery.
本研究旨在探讨腹主动脉瘤腔内修复术（EVAR）治疗后动脉瘤样髂动脉的转归。
我们分析了 Cook Zenith 试验的数据。随访时间为 1 个月、6 个月、12 个月，然后每年随访 5 年。根据最大髂动脉直径将患者分为 A 组（≥20mm）和 B 组（<20mm）。根据随访期间髂动脉增长≥5mm，将这些组进一步分为亚组。采用 Fisher 确切检验和 χ(2)检验。
736 例患者中，671 例接受了随访检查（A 组=274 例）。A 组中，220 例（80%）接受了髂总动脉分叉型支架植入。与 B 组相比，A 组髂动脉无明显增长。此外，两组患者髂动脉扩张率分别为 32.1%和 31.5%，两组相似。髂外动脉延长对生长无影响（P=0.4）。两组患者需要进行二次干预的比例无差异。然而，未发生生长的 A 组患者比未发生生长的 B 组患者更易发生远端Ⅰ型内漏（P=0.03）。两组严重不良事件（SAE）发生率无差异（P=0.51）。然而，与未发生生长的患者相比，发生髂动脉生长的患者发生 SAE 的可能性较小（P=0.035）。A、B 两组髂支过度扩张的平均百分比无差异。然而，发生髂动脉生长的 A、B 两组的平均过度扩张百分比明显高于未发生生长的患者（P<0.01）。
与正常髂动脉患者相比，AAA 腔内修复术时使用分叉型支架或髂外延伸支架治疗的动脉瘤样髂动脉不会发生未来的髂动脉生长、二次干预率增加或 SAE。这表明，适当大小的分支支架可安全植入髂总或髂外动脉，用于治疗动脉瘤样髂动脉。
