Bannazadeh Mohsen, Jenkins Christina, Forsyth Andrew, Kramer Jason, Aggarwal Ankur, Somerset Amy E, Bove Paul G, Long Graham W
Department of Surgery, Beaumont Health, Royal Oak, Mich.
Department of Radiology, Beaumont Health, Royal Oak, Mich.
J Vasc Surg. 2017 Nov;66(5):1390-1397. doi: 10.1016/j.jvs.2017.02.058. Epub 2017 Jul 8.
This study evaluated the morbidity of endovascular abdominal aortic aneurysm repair (EVAR) in patients with concomitant common iliac artery aneurysm (CCIAA).
This was a retrospective review of all patients who underwent elective EVAR from June 2006 through June 2012 at a single institution. Demographics, comorbidities, preoperative presentation, intraoperative details, and postoperative complications were tabulated. Patients with CCIAA were categorized into three groups according to the distal extent of their iliac limb: iliac limb extension into the external iliac artery with internal iliac artery coil embolization (EE); flared iliac limb ≥20 mm in diameter to the iliac bifurcation (FL); and iliac limb ≤20 mm ending proximal to the CCIAA (no-FL).
During this period, 627 consecutive patients underwent elective EVAR and preoperative computed tomographic angiograms were available for 523 patients to evaluate the presence of CCIAA. Of these, 211 patients (40.2%) had a CCIAA in at least one common iliac artery, with a total of 307 aneurysmal arteries. Of these 307 aneurysmal arteries, 62 (20.2%) were treated with EE, 132 (43.0%) were treated with FL, and 113 (36.8%) had a sufficient landing zone in the proximal common iliac artery to use an iliac limb ≤20 mm in diameter (no-FL). The overall reintervention rate was 12.4% of patients, with a higher reintervention rate between patients with CCIAA compared with those without (15.2% vs 10.9%; P = .039). There were no significant differences in reintervention rates between the EE, FL, and no-FL techniques (4.5% vs 4.8% vs 6.2%; P = .802) over a mean 59.8 months follow-up. The FL and EE techniques had a lower risk of distal endoleak than the no-FL technique, but the difference was not statistically significant (3.2% vs 2.3% vs 5.3% compared with 4.23% in the entire cohort).
Patients with CCIAA had a higher reintervention rate after EVAR for abdominal aortic aneurysm compared with non-CCIAA patients. Of the techniques studied (EE, FL, and no-FL), there was no significant difference in reintervention rates between the three. All three techniques remain viable options for the endovascular repair of CCIAA.
本研究评估了合并髂总动脉瘤（CCIAA）患者行血管腔内腹主动脉瘤修复术（EVAR）的发病率。
这是一项对2006年6月至2012年6月在单一机构接受择期EVAR的所有患者的回顾性研究。将人口统计学、合并症、术前表现、术中细节和术后并发症制成表格。根据髂支的远端范围，将患有CCIAA的患者分为三组：髂支延伸至髂外动脉并对髂内动脉进行弹簧圈栓塞（EE）；直径≥20mm的喇叭状髂支至髂总动脉分叉处（FL）；以及在CCIAA近端结束且直径≤20mm的髂支（无FL）。
在此期间，627例连续患者接受了择期EVAR，523例患者有术前计算机断层血管造影可用于评估CCIAA的存在。其中，211例患者（40.2%）至少一侧髂总动脉存在CCIAA，共有307条动脉瘤样动脉。在这307条动脉瘤样动脉中，62条（20.2%）采用EE治疗，132条（43.0%）采用FL治疗，113条（36.8%）在髂总动脉近端有足够的着陆区以使用直径≤20mm的髂支（无FL）。总体再干预率为患者的12.4%，CCIAA患者的再干预率高于无CCIAA患者（15.2%对10.9%；P = 0.039）。在平均59.8个月的随访中，EE、FL和无FL技术之间的再干预率无显著差异（4.5%对4.8%对6.2%；P = 0.802）。FL和EE技术的远端内漏风险低于无FL技术，但差异无统计学意义（3.2%对2.3%对5.3%，而整个队列中为4.23%）。
与非CCIAA患者相比，CCIAA患者行腹主动脉瘤EVAR后的再干预率更高。在所研究的技术（EE、FL和无FL）中，三者之间的再干预率无显著差异。所有三种技术仍然是血管腔内修复CCIAA的可行选择。
