Fujioka Shunichiro, Hosaka Shigeru, Morimura Hayato, Chen Ken, Wang Zhi Chao, Toguchi Koji, Fukuda Shoji, Takizawa Koki, Osawa Hiroshi
Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Cardiovascular Surgery, Shimada General Hospital, Choshi, Chiba, Japan.
Ann Vasc Dis. 2017 Dec 25;10(4):359-363. doi: 10.3400/avd.oa.17-00089.
: Patients of aorto-iliac aneurysms who undergo endovascular aortic repair (EVAR) require internal iliac artery (IIA) occlusion with coil embolization and its coverage with the stent graft to prevent type II endoleak after extending the endograft into the external iliac artery. However, it has become well recognized that IIA occlusion cause buttock claudication and other various sequelae due to pelvic ischemia. We retrospectively analyzed IIA occlusion outcomes. : From October 2008 to February 2015, 71 patients with aorto-iliac aneurysms underwent IIA occlusion prior to EVAR. The relationship between pelvic circulation and symptom of pelvic ischemia was studied. : Buttock claudication occurred in 17 patients (22.9%) of all. Eight patients (14.8%) in unilateral IIA occlusion group (54 patients) and nine patients (52.9%) in bilateral IIA group (17 patients) had sequelae of claudication. The sacrifice of the communication of superior gluteal artery (SGA) and inferior gluteal artery (IGA) led to buttock claudication in 18 (64.3%) of 28 limbs. Instead, only 4 of 60 limbs had buttock claudication, when we preserved the communication between SGA and IGA. In all patients, staged treatment of aorto-iliac aneurysms with IIA occlusion and EVAR were done successfully without pelvic ischemic complications except for buttock claudication, and postoperative CT scanning showed no endoleakage. : IIA occlusion prior to EVAR is recognized as a safe and reasonable strategy. It is emphasized that preservation of the communication of SGA and IGA is important to prevent buttock claudication. (This is a translation of Jpn J Vasc Surg 2016; 25: 240-245.).
接受血管腔内主动脉修复术（EVAR）的主-髂动脉瘤患者，需要通过弹簧圈栓塞闭塞髂内动脉（IIA），并用覆膜支架覆盖，以防止将覆膜支架延伸至髂外动脉后发生II型内漏。然而，人们已经充分认识到，IIA闭塞会因盆腔缺血导致臀部间歇性跛行和其他各种后遗症。我们回顾性分析了IIA闭塞的结果。：2008年10月至2015年2月，71例主-髂动脉瘤患者在接受EVAR之前先行IIA闭塞。研究了盆腔循环与盆腔缺血症状之间的关系。：在所有患者中，有17例（22.9%）出现臀部间歇性跛行。单侧IIA闭塞组（54例患者）中有8例（14.8%）、双侧IIA组（17例患者）中有9例（52.9%）出现间歇性跛行后遗症。臀上动脉（SGA）与臀下动脉（IGA）的交通支被牺牲导致28条肢体中有18条（64.3%）出现臀部间歇性跛行。相反，当我们保留SGA与IGA之间的交通支时，60条肢体中只有4条出现臀部间歇性跛行。在所有患者中，除臀部间歇性跛行外，分期进行IIA闭塞和EVAR治疗主-髂动脉瘤均成功，且无盆腔缺血并发症，术后CT扫描未显示内漏。：EVAR术前IIA闭塞被认为是一种安全合理的策略。强调保留SGA与IGA之间的交通支对于预防臀部间歇性跛行很重要。（本文翻译自《日本血管外科学杂志》2016年；25: 240 - 245.）
