Nitta Jun, Hoshina Katsuyuki, Isaji Toshihiko
Division of Vascular Surgery, Department of Surgery, The University of Tokyo, Tokyo, Japan.
Medicine (Baltimore). 2019 Feb;98(5):e14214. doi: 10.1097/MD.0000000000014214.
This study aimed to compare the pelvic cavity vasculature before and after the interventional occlusion of a hypogastric artery (IOHA) and to reveal the protective mechanism of the collateral vessels against pelvic ischaemia.Sixty-nine patients with abdominal aortic or aortoiliac aneurysms who underwent endovascular aneurysm repair accompanied with IOHA were retrospectively analysed. Patients were divided into those who complained of buttock claudication (BC) group and asymptomatic patients (non-BC group).Two analyses were performed. In Study 1, the factors associated with postoperative BC were evaluated in patients who underwent IOHA using only 0.035 Tornade embolization coils. In Study 2, the pelvic arterial volume (PAV) was assessed in patients with both pre- and postoperative multidetector computed tomography images. PAV was calculated by subtracting the aortoiliac artery volume from the total PAV. The PAV ratio was defined as the postoperative PAV divided by preoperative PAV and represented collateral development in the pelvis.In Study 1, BC occurred in 16 patients (BC group) and did not occur in 25 patients (non-BC group). Significantly more coils were used in the BC group than in the non-BC group (8.6 ± 1.0 vs 5.6 ± 0.83, P = .013). Study 2 had 24 patients in the BC group and 31 patients in the non-BC group. The PAV ratio was significantly higher in the BC group than in the non-BC group (0.93 ± 0.05 vs 0.62 ± 0.04, P<.0001).The use of more coils in IOHA is associated with BC. In addition, volumetric analysis revealed that less collateral vessel development occurred in the non-BC group than in the BC group, which might reflect a potential reservation capacity of non-BC patients for acute pelvic ischaemia.
本研究旨在比较髂内动脉介入栓塞术（IOHA）前后盆腔血管系统情况，并揭示侧支血管对盆腔缺血的保护机制。对69例行血管腔内动脉瘤修复术并伴有IOHA的腹主动脉或主髂动脉瘤患者进行回顾性分析。患者分为主诉臀部间歇性跛行（BC）组和无症状患者（非BC组）。进行了两项分析。在研究1中，对仅使用0.035 Tornade栓塞弹簧圈进行IOHA的患者，评估与术后BC相关的因素。在研究2中，对有术前和术后多排螺旋计算机断层扫描图像的患者评估盆腔动脉容积（PAV）。PAV通过从总PAV中减去主髂动脉容积来计算。PAV比值定义为术后PAV除以术前PAV，代表盆腔侧支血管的发育情况。在研究1中，16例患者发生BC（BC组），25例患者未发生BC（非BC组）。BC组使用的弹簧圈明显多于非BC组（8.6±1.0比5.6±0.83，P = 0.013）。研究2中，BC组有24例患者，非BC组有31例患者。BC组的PAV比值明显高于非BC组（0.93±0.05比0.6²±0.04，P<0.0001）。IOHA中使用更多弹簧圈与BC相关。此外，容积分析显示，非BC组侧支血管发育少于BC组，这可能反映了非BC患者对急性盆腔缺血的潜在储备能力。
