Unit of Vascular and Endovascular Surgery, Hospital S. Maria della Misericordia, S. Andrea delle Fratte, Perugia, Italy.
Eur J Vasc Endovasc Surg. 2012 Mar;43(3):287-92. doi: 10.1016/j.ejvs.2011.12.011. Epub 2012 Jan 10.
Iliac branch device (IBD) technique has been introduced as an appealing and effective solution to avoid complications occurring during repair of aorto-iliac aneurysm with extensive iliac involvement. Nevertheless, no large series with long-term follow-up of IBD are available. The aim of this study was to analyse safety and long-term efficacy of IBD in a consecutive series of patients.
Between 2006 and 2011, 100 consecutive patients were enrolled in a prospective database on IBD. Indications included unilateral or bilateral common iliac artery aneurysms combined or not with abdominal aneurysms. Patients were routinely followed up with computed tomography. Data were reported according to the Kaplan-Meier method.
There were 96 males, mean age 74.1 years. Preoperative median common iliac aneurysm diameter was 40 mm (interquartile range (IQR): 35-44 mm). Sixty-seven patients had abdominal aortic aneurysm >35 mm (IQR: 40-57 mm) associated with iliac aneurysm. Eleven patients presented hypogastric aneurysm. Twelve patients underwent isolated iliac repair with IBD and 88 patients received associated endovascular aortic repair. Periprocedural technical success rate was 95%, with no mortality. Two patients experienced external iliac occlusion in the first month. At a median follow-up of 21 months (range 1-60) aneurysm growth >3 mm was detected in four iliac (4%) arteries. Iliac endoleak (one type III and two distal type I) developed in three patients and buttock claudication in four patients. Estimated patency rate of internal iliac branch was 91.4% at 1 and 5 years. Freedom from any reintervention rate was 90% at 1 year and 81.4% at 5 years. No late ruptures occurred.
Long-term results show that IBD use can ensure persistent iliac aneurysm exclusion at 5 years, with low risk of reintervention. This technique can be considered as a first endovascular option in patients with extensive iliac aneurysm disease and favourable anatomy.
髂分支装置（IBD）技术已被引入，作为一种有吸引力且有效的解决方案，以避免在广泛累及髂动脉的腹主动脉-髂动脉瘤修复过程中出现并发症。然而，目前尚无长期随访的大型 IBD 系列研究。本研究旨在分析连续系列患者中 IBD 的安全性和长期疗效。
2006 年至 2011 年，100 例连续患者纳入 IBD 前瞻性数据库。适应证包括单侧或双侧髂总动脉瘤，合并或不合并腹主动脉瘤。患者常规接受计算机断层扫描随访。数据按照 Kaplan-Meier 方法报告。
96 例为男性，平均年龄 74.1 岁。术前髂总动脉瘤直径中位数为 40mm（四分位距（IQR）：35-44mm）。67 例患者腹主动脉瘤>35mm（IQR：40-57mm）合并髂动脉瘤。11 例患者存在髂内动脉瘤。12 例患者行单纯髂支修复，88 例患者行腹主动脉瘤腔内修复术。围手术期技术成功率为 95%，无死亡。2 例患者在术后第一个月出现髂外动脉闭塞。中位随访 21 个月（1-60 个月），4 例（4%）髂动脉发现动脉瘤生长>3mm。3 例患者发生髂内漏（1 型 3 例，2 型 1 例），4 例患者出现臀肌跛行。内髂分支通畅率为 1 年时 91.4%，5 年时 81.4%。无晚期破裂发生。
长期结果表明，IBD 使用可确保 5 年内持续排除髂动脉瘤，再次干预的风险较低。对于广泛累及髂动脉瘤病和有利解剖结构的患者，该技术可作为首选的腔内治疗方法之一。
