Domoto Satoru, Azuma Takashi, Yokoi Yoshihiko, Isomura Syogo, Takahashi Ken, Niinami Hiroshi
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University Hospital, 8-1 Kawada-cyo, Shinjyuku-ku, Tokyo, 162-8666, Japan.
Gen Thorac Cardiovasc Surg. 2019 Oct;67(10):835-840. doi: 10.1007/s11748-019-01096-5. Epub 2019 Feb 27.
To prevent buttock claudication, we performed endovascular aortic aneurysm repair (EVAR) for isolated internal iliac aneurysms (IIAAs) with selective preservation of the superior gluteal artery (SGA) flow. This study evaluates early clinical outcomes of this treatment.
We retrospectively evaluated 6 patients with isolated IIAA who underwent EVAR under local anesthesia between October 2017 and July 2018 at Tokyo Women's Medical University Hospital. We used self-expanding stent grafts to exclude the IIAA while preserving SGA flow. If necessary, we occluded the inferior gluteal artery and other branches with vascular plugs to prevent type II endoleak. The mean proximal neck diameter and length of the IIAAs to be 9.4 ± 2.4 mm and 17.7 ± 11.3 mm. The mean diameter of the SGA was 6.5 ± 0.9 mm. There were no procedural complications, and the mean procedure time was 84 ± 24 min. All patients were free from buttock claudication at follow-up. Postoperative computed tomography demonstrated a 100% primary patency rate of the SGA stent graft: there was no case of migration or endoleak.
EVAR for IIAAs with SGA flow preservation shows favorable early clinical outcomes. To prevent buttock claudication, SGA flow is necessary and sufficient. This novel approach is less invasive compared to conventional IIAA repair.
为预防臀部间歇性跛行，我们对孤立性髂内动脉瘤（IIAA）进行了血管腔内主动脉瘤修复术（EVAR），并选择性保留臀上动脉（SGA）血流。本研究评估了该治疗方法的早期临床结果。
我们回顾性评估了2017年10月至2018年7月在东京女子医科大学医院接受局部麻醉下EVAR治疗的6例孤立性IIAA患者。我们使用自膨式覆膜支架排除IIAA，同时保留SGA血流。如有必要，我们用血管栓塞封堵臀下动脉和其他分支，以预防II型内漏。IIAA的平均近端颈部直径和长度分别为9.4±2.4mm和17.7±11.3mm。SGA的平均直径为6.5±0.9mm。无手术并发症，平均手术时间为84±24分钟。所有患者在随访时均无臀部间歇性跛行。术后计算机断层扫描显示SGA覆膜支架的一期通畅率为100%：无移位或内漏病例。
保留SGA血流的IIAA的EVAR显示出良好的早期临床结果。为预防臀部间歇性跛行，SGA血流是必要且充分的。与传统的IIAA修复相比，这种新方法的侵入性较小。
