CHU Clermont-Ferrand, Department of Vascular Surgery, Clermont-Ferrand, France.
Chirurgie Vasculaire, HCL, Hôpital Édouard-Herriot Lyon, France.
Eur J Vasc Endovasc Surg. 2016 May;51(5):641-6. doi: 10.1016/j.ejvs.2015.12.021. Epub 2016 Feb 12.
During endovascular repair of abdominal aortic aneurysms (EVAR), in the absence of a distal iliac landing zone, the Amplatzer plug is increasingly being used to replace other internal iliac artery (IIA) embolization techniques. This study aimed at assessing the technical success, complication occurrence, and durability of the Amplatzer plug for IIA embolization.
From January 1, 2007 to December 31, 2013, all consecutive patients who underwent internal iliac embolization with an Amplatzer plug during EVAR were included in the study. There were 169 patients, (160 men, 9 women, mean 75 ± 9 years), treated by unilateral (158 cases, 93%) or bilateral (11 cases, 7%) embolization of the IIA, performed either separately prior to (65 cases, 38.5%) or during EVAR (104 cases, 61.5%). Follow up CT scan and/or US scan were performed 1 month after treatment and yearly thereafter. The inclusions were done retrospectively but the series was continuous and consecutive. Data were collected and analyzed using acquisition REDCap software.
The technical success rate was 97.6%. Failures were device migration (n = 1), navigation failure (n = 2), and release outside the target zone (n = 1). On average, 1.43 plugs were required to achieve the embolization. The average amount of contrast agent for the embolization procedure was 111 ± 51 mL and the radiation dose was 127,777 ± 89,528 mGy/cm(2). The total fluoroscopy time was 854 ± 538 seconds. No re-canalization of the IIA trunk was observed during follow up. Complications were buttock claudication (n = 41, 24.3%), which resolved in 24 cases (58.5%, 24/41) at the first follow up, and intestinal ischemia requiring limited bowel resection in two cases.
This multicenter study is the largest published to date. It demonstrates the efficacy and reliability of the Amplatzer plug to embolize the IIA during EVAR, with few side effects.
在腹主动脉瘤的血管内修复（EVAR）过程中，如果没有远端髂内动脉的着陆区，越来越多的是使用 Amplatzer 塞子来替代其他髂内动脉（IIA）栓塞技术。本研究旨在评估 Amplatzer 塞子用于 IIA 栓塞的技术成功率、并发症发生和耐久性。
从 2007 年 1 月 1 日至 2013 年 12 月 31 日，所有连续接受 EVAR 期间使用 Amplatzer 塞子进行 IIA 栓塞的患者均被纳入研究。共有 169 例患者（160 例男性，9 例女性，平均年龄 75±9 岁），行单侧（158 例，93%）或双侧（11 例，7%）IIA 栓塞，栓塞术分别在 EVAR 之前（65 例，38.5%）或 EVAR 期间（104 例，61.5%）进行。治疗后 1 个月及以后每年进行 CT 扫描和/或 US 扫描随访。虽然数据采集是回顾性的，但该系列是连续的。使用 REDCap 软件采集数据并进行分析。
技术成功率为 97.6%。失败的原因包括器械迁移（n=1）、导航失败（n=2）和释放超出目标区域（n=1）。平均需要 1.43 个塞子才能完成栓塞。栓塞过程中平均造影剂用量为 111±51mL，辐射剂量为 127777±89528mGy/cm2。总透视时间为 854±538 秒。在随访期间未观察到 IIA 主干再通。并发症包括臀肌跛行（n=41，24.3%），24 例（58.5%，24/41）在第一次随访时得到缓解，2 例发生需要有限肠切除的肠缺血。
这项多中心研究是迄今为止发表的最大规模的研究。它证明了 Amplatzer 塞子在 EVAR 期间栓塞 IIA 的有效性和可靠性，副作用较少。
