São Paulo Vascular and Endovascular Surgery Institute (ICVE-SP), São Paulo, Brazil.
J Vasc Surg. 2013 Feb;57(2 Suppl):26S-34S. doi: 10.1016/j.jvs.2012.09.081.
To ascertain midterm outcomes of the sandwich technique (ST) for internal iliac artery endorevascularization (ER).
All consecutive patients with complex aortoiliac aneurysms, isolated common iliac artery aneurysms, and abdominal aortic aneurysms with bilateral short, nondiseased common iliac artery undergoing elective endovascular aneurysm repair (EVAR) with the ST at our center, between October 2008 and March 2011, were invited to participate in the present study. Patients were considered eligible for this procedure only when their aneurysm features did not fulfill the requirements for standard EVAR. Follow-up assessments were carried out at 1 month and every 6 months thereafter and included computed tomographic angiography or duplex ultrasound. The study was approved by the Institutional Review Board, and all patients gave written informed consent.
A cohort of 40 patients (95% male; mean age, 72.2 years) was followed over a mean follow-up period of 12 ± 4.4 months (range: 6-30 months); 48 internal iliac artery (IIA) ER with ST were undertaken. Internal iliac artery aneurysm (IIAA) ER technical success rate was 100%. Primary patency rate was 93.8% on account of three IIA ER occlusions, occurring early in the study. Early and late related mortality rate was 0% and late unrelated mortality rate was 2.5%. Iliac aneurysm sac evolution demonstrated a significant (at least 5 mm) decrease in diameter in 16 (34.8%) common iliac artery aneurysms, no change in 29 (63%) common iliac artery aneurysms, and an increase in one patient (2.2%). Statistical significance was reached only for comparisons between baseline and 30 months (P = .039). Late buttock claudication rate was 0% after IIA ER with ST and 14.3% after IIA coil embolization.
The ST expands the limits of EVAR for complex aortoiliac aneurysms or IIAA in a safe, easy to perform, and cost-effective manner.
确定三明治技术（ST）用于髂内动脉血管内重建（ER）的中期结果。
2008 年 10 月至 2011 年 3 月期间，在我们中心，所有连续患有复杂主动脉髂动脉瘤、孤立性髂总动脉瘤和双侧短而无病变的髂总动脉瘤的患者，均符合行择期血管内腹主动脉瘤修复术（EVAR）的条件，并采用 ST 进行治疗。只有当患者的动脉瘤特征不符合标准 EVAR 的要求时，才考虑进行此手术。术后 1 个月和此后每 6 个月进行一次随访评估，包括计算机断层血管造影或双功能超声检查。本研究得到了机构审查委员会的批准，所有患者均签署了书面知情同意书。
40 例患者（95%为男性；平均年龄 72.2 岁）被纳入研究，平均随访 12 ± 4.4 个月（范围：6-30 个月）；共进行了 48 例 ST 下的髂内动脉 ER。髂内动脉动脉瘤（IIAA）ER 的技术成功率为 100%。由于 3 例早期发生的髂内动脉 ER 闭塞，初始通畅率为 93.8%。早期和晚期相关死亡率为 0%，晚期非相关死亡率为 2.5%。髂动脉瘤囊的演变显示，16 例（34.8%）髂总动脉瘤的直径至少减少了 5 毫米，29 例（63%）髂总动脉瘤无变化，1 例患者（2.2%）增加。仅在基线与 30 个月时的比较中达到统计学意义（P =.039）。采用 ST 行髂内动脉 ER 后晚期臀部跛行发生率为 0%，采用 IIA 线圈栓塞后为 14.3%。
ST 以安全、易于操作且具有成本效益的方式扩展了 EVAR 治疗复杂主动脉髂动脉瘤或 IIAA 的适应证。
