Duran Cassidy, Naoum Joseph J, Smolock Christopher J, Bavare Charudatta S, Patel Mitul S, Anaya-Ayala Javier E, Lumsden Alan B, Davies Mark G
Department of Cardiovascular Surgery, Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, TX 77030, USA.
Ann Vasc Surg. 2013 Jan;27(1):1-7. doi: 10.1016/j.avsg.2012.04.017. Epub 2012 Sep 12.
Intraoperative rupture of the iliac artery is a serious complication of endovascular aneurysm repair (EVAR), the outcomes of which have changed with increasing experience and improved endovascular tools over the past 2 decades. Over the past 15 years, the incidence and management of iliac rupture has changed as devices have improved and experience has grown. This study reviews our longitudinal experience with this complication.
All cases of iliac artery rupture during EVAR from 1997 through 2011 were reviewed for presentation, treatment strategies, and outcomes.
Iliac artery rupture complicated 20 (3%) of 707 EVARs performed. Sixteen (80%) common and four (20%) external iliac arteries were ruptured. Hypotension (systolic blood pressure: <90 mm Hg) was present in 11 (55%) cases. Five open bypasses were performed (25%), whereas 15 were repaired using an endovascular approach (75%). All open repairs (100%) were associated with postoperative morbidity (one wound infection, four multiorgan system failure), whereas three of the 15 patients (23%) repaired endovascularly experienced postoperative morbidity (cerebrovascular accident, myocardial infarction, line infection). There were no intraoperative deaths. There were four (20%) early deaths in the intensive care unit (<3 days postoperatively), all of which were associated with resection of bilateral hypogastric arteries and were due to complications of pelvic ischemia and/or multiorgan system failure.
Iliac artery rupture remains relatively uncommon but can carry a high morbidity and mortality. As device technology, imaging quality for preoperative planning, and experience level have improved, iliac rupture has become less common, and outcomes in the setting of iliac rupture have significantly improved. Endoluminal management has evolved as the primary treatment strategy. Resection of both hypogastric arteries is associated with mortality from pelvic ischemia, a likely indicator of systemic disease.
髂动脉术中破裂是血管内动脉瘤修复术（EVAR）的一种严重并发症，在过去20年里，随着经验的增加和血管内工具的改进，其结果发生了变化。在过去15年中，随着器械的改进和经验的积累，髂动脉破裂的发生率和处理方式也发生了改变。本研究回顾了我们在这一并发症方面的长期经验。
回顾了1997年至2011年期间EVAR术中发生髂动脉破裂的所有病例，分析其临床表现、治疗策略及结果。
在707例EVAR手术中，有20例（3%）发生了髂动脉破裂。其中16例（80%）为髂总动脉破裂，4例（20%）为髂外动脉破裂。11例（55%）患者出现低血压（收缩压<90 mmHg）。5例（25%）进行了开放旁路手术，15例（75%）采用血管内方法修复。所有开放修复手术（100%）均伴有术后并发症（1例伤口感染，4例多器官系统衰竭），而15例血管内修复患者中有3例（23%）出现术后并发症（脑血管意外、心肌梗死、导管感染）。术中无死亡病例。重症监护病房有4例（20%）早期死亡（术后<3天），均与双侧髂内动脉切除有关，原因是盆腔缺血和/或多器官系统衰竭并发症。
髂动脉破裂仍然相对少见，但可导致较高的发病率和死亡率。随着器械技术、术前规划的影像质量和经验水平的提高，髂动脉破裂已变得不那么常见，且髂动脉破裂情况下的治疗结果有了显著改善。腔内治疗已成为主要的治疗策略。双侧髂内动脉切除与盆腔缺血导致的死亡相关，这可能是全身疾病的一个指标。
