Khilchuk Anton, Vlasenko Sergei, Muradyan Musheg, Agarkov Maksim, Abdulkarim Dana, Shcherbak Sergei, Gladyshev Dmitrii, Sarana Andrei, Litvinovskii Sergei, Kovalik Vladislav
Department of Interventional Radiology, Saint-Petersburg City Hospital №40, Borisova str. 9, Sestroretsk, Saint-Petersburg 197706, Russian Federation.
Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation.
Radiol Case Rep. 2019 Sep 18;14(11):1394-1400. doi: 10.1016/j.radcr.2019.09.007. eCollection 2019 Nov.
We present a case of a CT-fusion-guided endovascular repair of an iatrogenic common iliac artery aneurysm in a 60-year-old male with a history of robotic prostatectomy with wide lymphadenectomy. Taking into account iatrogenic nature, rapid evolvement, previous surgical intervention, and oncological history, our team, including vascular and endovascular surgeons, refused open surgery in favor of endovascular iliac repair. We coiled the ipsilateral hypogastric artery and then deployed 2 Fluency Plus stent grafts from the common iliac into the external iliac artery. All manipulations were made under CT-fusion vascular mask control, which provided precise neck positioning, a minimal contrast infusion, reduced radiation dose, and better overall control. Our results suggest that anatomically suitable isolated iliac aneurysms can be successfully and safely treated with CT-fusion-guided endovascular repair without major perioperative and mid-term complications. The case is highlighting the potential complexity of repeated surgery with previously operated patients and the necessity of surgical and endovascular team interactions, especially in case of iatrogenic vascular complications.
我们报告了一例60岁男性医源性髂总动脉瘤的CT融合引导下血管内修复病例,该患者有机器人辅助前列腺切除术及广泛淋巴结清扫病史。考虑到其医源性本质、快速进展、既往手术干预及肿瘤病史,我们的团队,包括血管外科和血管内外科医生,拒绝了开放手术,而选择血管内髂动脉修复术。我们栓塞了同侧的髂内动脉,然后从髂总动脉到股外动脉植入了2枚Fluency Plus覆膜支架。所有操作均在CT融合血管面罩控制下进行,这提供了精确的颈部定位、最小的造影剂注入量、降低的辐射剂量以及更好的整体控制。我们的结果表明,解剖结构合适的孤立性髂动脉瘤可以通过CT融合引导下的血管内修复成功且安全地治疗,且无重大围手术期和中期并发症。该病例凸显了既往手术患者再次手术的潜在复杂性以及手术和血管内团队协作的必要性,尤其是在医源性血管并发症的情况下。