Division of Vascular Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif 90095, USA.
J Vasc Surg. 2012 Nov;56(5):1252-9. doi: 10.1016/j.jvs.2012.04.070. Epub 2012 Jun 27.
To assess technical feasibility and short-term outcome of a novel hypogastric preservation technique in patients with aortoiliac aneurysms using commercially available endografts without device modification.
Multi-institution review of prospectively acquired database of patients undergoing double-barrel endograft repair of aortoiliac aneurysms.
Twenty-two patients underwent endovascular aneurysm repair for aortoiliac aneurysms from 2010 to 2011, with 23 double-barrel hypogastric preservation procedures successfully completed in 21 patients. The technique involved bifurcated main body placement followed by simultaneous deployment of parallel endograft limbs into the external iliac (ipsilateral approach) and hypogastric (contralateral femoral or brachial approach) arteries. Bilateral hypogastric branches were performed in two patients, and unilateral branches with and without contralateral coil embolization were performed in nine and ten patients, respectively. Procedural success rate was 96%, technical success rate (successful implantation with immediate aneurysm exclusion and no observed endoleak) was 88%, and access was fully-percutaneous in 86%. Two type III endoleaks between branch components were noted on completion angiograms, but both resolved spontaneously on follow-up imaging. One type Ib endoleak was noted on postoperative imaging (contralateral to hypogastric branch, repaired with limb extension), as were three type II endoleaks (14%) without sac expansion. Early (<2 weeks) limb occlusion (one external iliac, two hypogastric) occurred in two patients, though no subsequent occlusions have occurred (mean follow-up, 7.2 months; range, 1-20 months). Primary patency for external iliac and hypogastric limbs at 6 months was 95% and 88%, respectively. There were no deaths; complications included groin hematoma in 10% and acute renal insufficiency in 5%. Buttock claudication (n = 4) only occurred in patients who had ipsilateral coil embolization of hypogastric arteries (n = 9) for bilateral iliac aneurysms in which only unilateral hypogastric preservation was performed, resulting in rate of 44% in these patients.
The double-barrel technique for hypogastric preservation is technically feasible across multiple interventionalists using commercially available endografts without device modification. These procedures are associated with minimal morbidity, acceptable short-term limb-patency rates, and reduced buttock claudication compared with those involving contralateral hypogastric embolization.
评估在不修改设备的情况下，使用市售腔内移植物对腹主动脉瘤患者进行新型腹主动脉保留技术的技术可行性和短期结果。
对 2010 年至 2011 年接受腹主动脉瘤双桶腔内修复术的患者进行前瞻性采集数据库的多机构回顾。
22 例患者因腹主动脉瘤接受血管内动脉瘤修复，21 例患者成功完成 23 例双桶腹主动脉保留术。该技术涉及分叉主体放置，然后同时将平行的移植物分支部署到髂外动脉（同侧入路）和腹主动脉（对侧股动脉或肱动脉入路）。两名患者进行了双侧腹主动脉分支，9 名和 10 名患者分别进行了单侧分支和对侧线圈栓塞。手术成功率为 96%，技术成功率（成功植入，即刻排除动脉瘤，无观察到内漏）为 88%，86%的入路完全经皮。完成血管造影显示有两个分支组件之间的 III 型内漏，但在随访成像中均自发缓解。术后成像显示有一个 Ib 型内漏（对侧分支，用分支延伸修复），以及三个 II 型内漏（14%），无囊扩张。两名患者在早期（<2 周）出现肢体闭塞（1 个髂外，2 个腹主动脉），但随后没有再发生闭塞（平均随访时间 7.2 个月；范围 1-20 个月）。6 个月时髂外和腹主动脉分支的初始通畅率分别为 95%和 88%。无死亡病例；并发症包括 10%的腹股沟血肿和 5%的急性肾功能不全。臀肌跛行（n=4）仅发生在 9 例接受对侧腹主动脉线圈栓塞的患者中（n=9），这些患者的双侧髂动脉瘤行单侧腹主动脉保留，导致这些患者的发生率为 44%。
使用市售移植物，多位介入医生采用双桶技术进行腹主动脉保留是可行的，无需对设备进行修改。与涉及对侧腹主动脉栓塞的手术相比，这些手术具有较低的发病率、可接受的短期肢体通畅率和较低的臀肌跛行率。
