Dierks Alexander, Sauer Alexander, Wolfschmidt Franziska, Hassold Nicole, Kellersmann Richard, Bley Thorsten A, Kickuth Ralph
1 Department of Diagnostic and Interventional Radiology, University Hospital of Wuerzburg, Würzburg, Germany.
2 Department of General, Visceral, Vascular and Paediatric Surgery, University of Wuerzburg, Würzburg, Germany.
Br J Radiol. 2017 Apr;90(1072):20160527. doi: 10.1259/bjr.20160527. Epub 2017 Mar 3.
Occlusion of the internal iliac artery (IIA) may be necessary prior to endovascular aneurysm repair (EVAR) to prevent endoleak Type II. We compared efficacy and clinical outcome after proximal occlusion of an unaffected IIA (ProxEmbx) using an Amplatzer vascular plug (AVP) I vs distal occlusion of aneurysmatic IIA with coils and plugs (DistEmbx).
Between 2009 and 2012, 22 patients underwent EVAR. In 9 patients with unaffected IIA, occlusion was performed by a single AVP. In 13 patients with aneurysmatic IIA, more distal embolization (DistEmbX) was conducted by using several coils and additional AVPs. Retrospectively, technical success, clinical outcome and complications were evaluated.
Embolization of the IIA was successful in all patients. Three patients with more DistEmbX of aneurysmatic IIAs suffered from new onset of sexual dysfunction after occlusion without statistically significant difference (p > 0.05). Transient buttock claudication was observed in three patients in each group. Bowel ischaemia did not occur. The procedure time (p = 0.013) and fluoroscopy time (p = 0.038) was significantly lower in the ProxEmbx group than in the DistEmbx group.
Proximal occlusion of an unaffected IIA and more distal occlusion of an aneurysmatic IIA prior to EVAR had the same technical and clinical outcome. However, proximal plug embolization of an unaffected IIA prior to EVAR was associated with shorter procedure and fluoroscopy time in comparison with more DistEmbX of aneurysmatic IIAs. Advances in knowledge: Proximal embolization of unaffected IIA and DistEmbX of aneurysmatic IIA before EVAR are both effective in preventing Type II endoleaks and have the same technical and clinical outcome.
在血管内动脉瘤修复术（EVAR）之前，可能需要闭塞髂内动脉（IIA）以预防II型内漏。我们比较了使用Amplatzer血管塞（AVP）I对未受影响的IIA进行近端闭塞（ProxEmbx）与使用弹簧圈和栓塞物对动脉瘤性IIA进行远端闭塞（DistEmbx）后的疗效和临床结果。
2009年至2012年间，22例患者接受了EVAR。9例未受影响的IIA患者通过单个AVP进行闭塞。13例动脉瘤性IIA患者通过使用多个弹簧圈和额外的AVP进行更远端的栓塞（DistEmbX）。回顾性评估技术成功率、临床结果和并发症。
所有患者的IIA栓塞均成功。3例进行了更多动脉瘤性IIA远端栓塞（DistEmbX）的患者在闭塞后出现了新发性功能障碍，但差异无统计学意义（p＞0.05）。每组各有3例患者出现短暂性臀部跛行。未发生肠缺血。ProxEmbx组的手术时间（p = 0.013）和透视时间（p = 0.038）显著低于DistEmbx组。
EVAR前对未受影响的IIA进行近端闭塞和对动脉瘤性IIA进行更远端闭塞具有相同的技术和临床结果。然而，与对动脉瘤性IIA进行更多远端栓塞（DistEmbX）相比，EVAR前对未受影响的IIA进行近端栓塞与更短的手术和透视时间相关。知识进展：EVAR前对未受影响的IIA进行近端栓塞和对动脉瘤性IIA进行远端栓塞（DistEmbX）在预防II型内漏方面均有效，且具有相同的技术和临床结果。
