Shintani Tsunehiro, Mitsuoka Hiroshi, Hasegawa Yuto, Hayashi Masanori, Natsume Kayoko, Ookura Kazuhiro, Sato Yasunori, Obara Hideaki
Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan.
Department of Cardiovascular Surgery, Shizuoka Hospital, Shizuoka, Japan.
Ann Vasc Surg. 2020 Jul;66:120-131. doi: 10.1016/j.avsg.2020.01.009. Epub 2020 Jan 14.
Although the use of aneurysmal common iliac artery (CIA) as the landing zone during endovascular aortic aneurysm repair EVAR remains an essential procedure, this procedure may increase the risk of late complications such as ongoing CIA dilatation and type Ib endoleak (CIA-related complications). We hypothesized that incomplete sealing of the aneurysmal CIA segment during EVAR could increase the incidence of CIA-related complications. In this study, we evaluated the midterm results of EVAR with aneurysmal CIA used as the landing zone and assessed the importance of distal sealing in this procedure.
We retrospectively reviewed all cases of endovascular aneurysm repair using CIA as landing zone between 2007 and 2015 that had at least 3 years' follow-up. We defined aneurysmal CIA as maximum diameter ≥18 mm. The main outcome was the incidence of CIA-related complications. We compared midterm results between normal CIA and aneurysmal CIA. Next, we analyzed risk factors for CIA-related complications in aneurysmal CIA.
Four complications occurred in normal CIA (mean follow-up, 66.5 ± 22.1 months); 21 occurred in aneurysmal CIA (mean follow-up, 62.2 ± 20.5 months). The 5-year portion of freedom from CIA-related complications was 97.3% in normal CIA and 69.4% in aneurysmal CIA (P < 0.001). Multivariable analysis in aneurysmal CIA showed that unsealed CIA segment length was only risk factor for CIA-related complications. Given the receiver operating characteristic curve results, we defined the unsealed CIA segment ≥10 mm as incomplete sealing. The hazard ratio for incomplete sealing associated with CIA-related complications was 3.92 (95% confidence interval 1.62-9.46, P = 0.02).
Use of aneurysmal CIA as landing zone increases the risk of CIA-related complications. However, maximum sealing of the aneurysmal CIA segment could prevent these complications.
尽管在血管腔内主动脉瘤修复术（EVAR）中使用动脉瘤性髂总动脉（CIA）作为着陆区仍然是一项重要手术，但该手术可能会增加诸如持续性CIA扩张和Ib型内漏等晚期并发症（与CIA相关的并发症）的风险。我们推测，在EVAR期间动脉瘤性CIA节段的不完全密封可能会增加与CIA相关并发症的发生率。在本研究中，我们评估了以动脉瘤性CIA作为着陆区的EVAR的中期结果，并评估了该手术中远端密封的重要性。
我们回顾性分析了2007年至2015年间所有以CIA作为着陆区且至少有3年随访期的血管腔内动脉瘤修复病例。我们将动脉瘤性CIA定义为最大直径≥18mm。主要结局是与CIA相关并发症的发生率。我们比较了正常CIA和动脉瘤性CIA的中期结果。接下来，我们分析了动脉瘤性CIA中与CIA相关并发症的危险因素。
正常CIA发生4例并发症（平均随访时间，66.5±22.1个月）；动脉瘤性CIA发生21例并发症（平均随访时间，62.2±20.5个月）。正常CIA中与CIA相关并发症的5年无事件生存率为97.3%，动脉瘤性CIA中为69.4%（P<0.001）。对动脉瘤性CIA的多变量分析表明，未密封的CIA节段长度是与CIA相关并发症的唯一危险因素。根据受试者工作特征曲线结果，我们将未密封的CIA节段≥10mm定义为不完全密封。与CIA相关并发症相关的不完全密封的风险比为3.92（95%置信区间1.62-9.46，P=0.02）。
使用动脉瘤性CIA作为着陆区会增加与CIA相关并发症的风险。然而，对动脉瘤性CIA节段进行最大程度的密封可以预防这些并发症。
