Machado Rui Manuel, Rego Duarte Nuno Cunha, de Oliveira Pedro Nuno Ferreira Pinto, de Almeida Rui Manuel Gonçalves Fernandes
Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal.
Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.
Braz J Cardiovasc Surg. 2016 Apr;31(2):127-31. doi: 10.5935/1678-9741.20160023.
Internal iliac artery aneurysms (IIAA) are rare, representing only 0.3% of aortoiliac aneurysms. Its treatment with open surgery is complex and associated with high morbidity and mortality, which led to increasing application of endovascular solutions. In this study, we aimed to evaluate outcomes of endovascular aneurysm repair (EVAR) of IIAA in one institution.
We retrospectively reviewed all cases of IIAA treated with endovascular techniques between 2003 and 2014. Endpoints were morbidity, mortality, freedom from pelvic ischemic symptoms (buttock claudication, ischemic colitis, and spinal cord injury), and need for reintervention.
There were 16 patients, 13 males and 3 females, with mean age of 75.1±7 years. A total of 20 IIAA (4 cases were bilateral), with mean diameter of 37.9 mm, were treated. EVAR was performed in 13 (81.3%) patients, with associated internal iliac artery's outflow occlusion in 2. Iliac branch device was used in one patient. Two patients underwent endovascular IIAA embolization alone. One patient underwent percutaneous, transgluteal, IIAA embolization. IIAA flow preservation in at least one internal iliac artery was possible in 9 (56.3%) patients. Early mortality was 7% (1 case). Early morbidity was 18.8%. Pelvic ischemic complications occurred in 1 (7%) patient with buttock claudication. Late reintervention was needed in 3 patients, none of them for IIAA related complications.
Endovascular treatment of IIAA is technically feasible and durable. Although overall morbidity is relatively high, major complications are infrequent and perioperative mortality is low. internal iliac artery flow preservation is technically challenging and, in a significant number of cases, not possible at all.
髂内动脉瘤（IIAA）较为罕见，仅占主髂动脉瘤的0.3%。其开放手术治疗复杂，且发病率和死亡率较高，这使得血管腔内治疗方法的应用日益增多。在本研究中，我们旨在评估某一机构中IIAA的血管腔内动脉瘤修复术（EVAR）的疗效。
我们回顾性分析了2003年至2014年间采用血管腔内技术治疗的所有IIAA病例。观察指标包括发病率、死亡率、无盆腔缺血症状（臀部间歇性跛行、缺血性结肠炎和脊髓损伤）以及再次干预的需求。
共有16例患者，其中男性13例，女性3例，平均年龄为75.1±7岁。共治疗20个IIAA（4例为双侧），平均直径为37.9mm。13例（81.3%）患者接受了EVAR治疗，其中2例伴有髂内动脉流出道闭塞。1例患者使用了髂支支架。2例患者仅接受了血管腔内IIAA栓塞术。1例患者接受了经皮、经臀IIAA栓塞术。9例（56.3%）患者至少保留了一条髂内动脉的血流。早期死亡率为7%（1例）。早期发病率为18.8%。1例（7%）患者出现臀部间歇性跛行的盆腔缺血并发症。3例患者需要后期再次干预，均与IIAA相关并发症无关。
IIAA的血管腔内治疗在技术上是可行且持久的。尽管总体发病率相对较高，但主要并发症并不常见，围手术期死亡率较低。保留髂内动脉血流在技术上具有挑战性，并且在相当多的病例中根本无法实现。
