Laine Matti T, Björck Martin, Beiles C Barry, Szeberin Zoltán, Thomson Ian, Altreuther Martin, Debus E Sebastian, Mani Kevin, Menyhei Gábor, Venermo Maarit
Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
J Vasc Surg. 2017 Jan;65(1):76-81. doi: 10.1016/j.jvs.2016.06.109.
This study investigated the diameter of internal iliac artery (IIA) aneurysms (IIAAs) at the time of rupture to evaluate whether the current threshold diameter for elective repair of 3 cm is reasonable. The prevalence of concomitant aneurysms and results of surgical treatment were also investigated.
This was a retrospective analysis of patients with ruptured IIAA from seven countries. The patients were collected from vascular registries and patient records of 28 vascular centers. Computed tomography images taken at the time of rupture were analyzed, and maximal diameters of the ruptured IIA and other aortoiliac arteries were measured. Data on the type of surgical treatment, mortality at 30 days, and follow-up were collected.
Sixty-three patients (55 men and 8 women) were identified, operated on from 2002 to 2015. The patients were a mean age of 76.6 years (standard deviation, 9.0; range 48-93 years). A concomitant common iliac artery aneurysm was present in 65.0%, 41.7% had a concomitant abdominal aortic aneurysm, and 36.7% had both. IIAA was isolated in 30.0%. The mean maximal diameter of the ruptured artery was 68.4 mm (standard deviation, 20.5 mm; median, 67.0 mm; range, 25-116 mm). One rupture occurred at <3 cm and four at <4 cm (6.3% of all ruptures). All patients were treated, 73.0% by open repair and 27.0% by endovascular repair. The 30-day mortality was 12.7%. Median follow-up was 18.3 months (interquartile range, 2.0-48.3 months). The 1-year Kaplan-Meier estimate for survival was 74.5% (standard error, 5.7%).
IIAA is an uncommon condition and mostly coexists with other aortoiliac aneurysms. Follow-up until a diameter of 4 cm seems justified, at least in elderly men, although lack of surveillance data precludes firm conclusions. The mortality was low compared with previously published figures and lower than mortality in patients with ruptured abdominal aortic aneurysm.
本研究调查了髂内动脉瘤（IIAA）破裂时的直径，以评估目前3 cm的择期修复阈值直径是否合理。还调查了合并动脉瘤的患病率及手术治疗结果。
这是一项对来自七个国家的IIAA破裂患者的回顾性分析。患者从28个血管中心的血管登记处和患者记录中收集。分析破裂时的计算机断层扫描图像，测量破裂的髂内动脉及其他主髂动脉的最大直径。收集手术治疗类型、30天死亡率及随访的数据。
共确定63例患者（55例男性和8例女性），于2002年至2015年接受手术。患者平均年龄为76.6岁（标准差9.0；范围48 - 93岁）。65.0%的患者合并髂总动脉瘤，41.7%合并腹主动脉瘤，36.7%两者均有。孤立性IIAA占30.0%。破裂动脉的平均最大直径为68.4 mm（标准差20.5 mm；中位数67.0 mm；范围25 - 116 mm）。1例破裂发生在<3 cm，4例发生在<4 cm（占所有破裂的6.3%）。所有患者均接受了治疗，73.0%采用开放修复，27.0%采用血管腔内修复。30天死亡率为12.7%。中位随访时间为18.3个月（四分位间距2.0 - 48.3个月）。1年Kaplan-Meier生存估计值为74.5%（标准误5.7%）。
IIAA是一种罕见疾病，大多与其他主髂动脉瘤并存。至少在老年男性中，随访至直径4 cm似乎是合理的，尽管缺乏监测数据无法得出确凿结论。与先前公布的数据相比，死亡率较低，且低于腹主动脉瘤破裂患者的死亡率。
