Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100032, China.
Chin Med J (Engl). 2011 Dec;124(23):4105-8.
Endovascular aneurysm repair (EVAR) has been proven to be an effective and safe technique for abdominal or iliac artery aneurysm. However, for aneurysms extending to both iliac bifurcations, routine EVAR will occlude both internal iliac arteries (IIAs), which may increase the risk for pelvic ischemia. New endovascular techniques have been developed to preserve the pelvic perfusion in EVAR for such situation. This article reports an endovascular repair of an aortoiliac aneurysm with an external iliac artery (EIA) to the IIA endograft to preserve the pelvic perfusion. First, an endograft was advanced into the left IIA under the help of an inflated aortic balloon. Coils were deployed to embolize the distal type-1 endoleak from the tunnel around the endograft. and an aortouniiliac endograft and an iliac extension were deployed below the renal arteries extending to the right EIA. Finally, a right-to-left femoro-femoral artery bypass was constructed. Angiography at completion and computed tomography after 6 months demonstrated patency of all grafts and complete exclusion of the aneurysm without any endoleak. Endovascular repair with an EIA-to-IIA endograft to preserve the pelvic inflow is a feasible and effective technique for aortoiliac aneurysms. Coil embolization might be an option to repair the distal type of endoleak. The balloon assisted U-turn technique may help advance the endovascular device over a sharp-angled vessel bifurcation.
血管内动脉瘤修复术（EVAR）已被证明是治疗腹主动脉瘤或髂动脉瘤的有效且安全的技术。然而，对于延伸至双侧髂动脉分叉的动脉瘤，常规 EVAR 将闭塞双侧髂内动脉（IIA），这可能会增加骨盆缺血的风险。为了在这种情况下保留 EVAR 中的骨盆灌注，已经开发了新的血管内技术。本文报告了一例使用髂外动脉（EIA）至 IIA 分支型移植物进行血管内修复以保留骨盆灌注的腹主动脉瘤。首先，在充气主动脉球囊的帮助下，将移植物推进到左侧 IIA。通过在移植物周围的隧道中部署线圈来栓塞来自远端 1 型内漏的血液。并在肾动脉下方部署腹主动脉-髂动脉移植物和髂内分支，延伸至右侧 EIA。最后，构建了右侧至左侧股-股动脉旁路。完成时的血管造影和 6 个月后的计算机断层扫描显示所有移植物通畅，动脉瘤完全被排除，没有任何内漏。使用 EIA 至 IIA 分支型移植物保留骨盆流入的血管内修复对于腹主动脉瘤是一种可行且有效的技术。线圈栓塞可能是修复远端内漏的一种选择。球囊辅助的 U 型转弯技术可能有助于将血管内设备推进到锐角血管分叉处。
