Karelis Angelos, Dijkstra Martijn L, Singh Bharti, Vaccarino Roberta, Sonesson Björn, Dias Nuno V
Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden.
Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden; Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Ann Vasc Surg. 2020 Aug;67:171-177. doi: 10.1016/j.avsg.2020.02.019. Epub 2020 Mar 20.
The objective of this study was to evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms.
Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (the median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery aneurysm (n = 4) or isolated CIA aneurysms (n = 2). The main outcome measures were technical and clinical success. The secondary outcomes were primary and primary assisted patency, the occurrence of type I/III endoleaks, and reinterventions.
All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (the median total procedure time of 188 min and the median IBD procedure time of 28 min). The median follow-up was 34 months (interquartile range 19-78). There were no deaths during the follow-up and no major complications unrelated to the IBD. Two (25%) secondary interventions were performed for IBD occlusion in patients with bilateral IBDs. The other reintervention was a type II endoleak embolization in 1 of these 2 patients. The freedom from reintervention estimate was 75% through 2 years. The overall primary assisted patency was 100% through 3 years.
The use of IBDs in the acute setting is feasible to exclude ruptured aortoiliac aneurysms while maintaining pelvic circulation. The secondary intervention rate is considerable; however, the midterm assisted primary patency rates are promising. Further studies are needed to guide patient selection and to evaluate longer term outcomes.
本研究的目的是评估在破裂性主-髂动脉瘤的急诊血管内修复中，髂支装置（IBD）保留髂内动脉灌注的可行性和中期结果。
2012年12月至2017年7月期间，在一家三级转诊中心，6例患者（中位年龄65岁；均为男性）共植入了8个IBD。IBD植入的指征为破裂性腹主动脉瘤合并髂总动脉瘤（n = 4）或孤立性髂总动脉瘤（n = 2）。主要结局指标为技术成功和临床成功。次要结局为一期和一期辅助通畅率、Ⅰ/Ⅲ型内漏的发生情况以及再次干预情况。
所有患者在局部麻醉下进行手术过程中血流动力学稳定。所有病例均实现技术成功（中位总手术时间为188分钟，中位IBD手术时间为28分钟）。中位随访时间为34个月（四分位间距为19 - 78个月）。随访期间无死亡病例，且无与IBD无关的严重并发症。2例双侧植入IBD的患者因IBD闭塞进行了二次干预（25%）。这2例患者中的1例还进行了1次Ⅱ型内漏栓塞术。2年时无需再次干预的估计概率为75%。3年时总体一期辅助通畅率为100%。
在急性情况下使用IBD排除破裂性主-髂动脉瘤并维持盆腔循环是可行的。二次干预率较高；然而，中期辅助一期通畅率前景良好。需要进一步研究以指导患者选择并评估长期结果。
