Vascular Surgery Unit, Department of Surgical Sciences, University of Turin, Turin, Italy.
Vascular Surgery Unit, Department of Surgical Sciences, University of Turin, Turin, Italy.
Eur J Vasc Endovasc Surg. 2020 Sep;60(3):356-364. doi: 10.1016/j.ejvs.2020.05.022. Epub 2020 Jul 21.
The purpose of this study was to evaluate the long term results of endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysm (AAA) and ectatic common iliac arteries (CIAs).
In a retrospective analysis of a prospectively collected database in two high volume centres, patients with AAAs undergoing elective standard EVAR were divided into two groups: those with both CIA diameters <18 mm, and those with at least one ectatic iliac artery (CIA ≥ 18 mm). Patients with an intentional external iliac artery landing zone were excluded. Primary outcomes were survival and freedom from re-intervention. Secondary end points were EVAR failure and iliac related endoleak and iliac re-intervention.
From 2000 to 2015, 648 patients were included in the study, 277 (43%) had at least one CIA ≥ 18 mm. Pre-operative risk factors were similar between the two groups, with the exception of chronic renal insufficiency (p = .010) and cerebrovascular events (p = .040), which were higher in the ectatic CIA group. At 30 days from primary procedure, there was a higher rate of type Ib endoleak in patients with ectatic iliacs (p = .020). A statistically significant increase in the incidence of late type Ib endoleak in patients with ectatic iliac arteries was confirmed at a mean follow up of 74.8 months (p = .01). The need for iliac related re-intervention was higher in patients with CIAs ≥18 mm (odds ratio 1.94; 95% confidence interval 1.1-3.2).
Ectatic iliac arteries are considered suitable landing zones for EVAR, although there is an increased risk of secondary interventions in time mainly due to late CIA dilation and secondary type Ib endoleak. Patients receiving EVAR with flared iliac limbs may benefit a more intensive surveillance to avoid late failures.
本研究旨在评估腹主动脉瘤（AAA）伴髂总动脉扩张患者行血管内动脉瘤修复术（EVAR）的长期疗效。
对两个大容量中心前瞻性收集数据库的回顾性分析中，将接受择期标准 EVAR 的 AAA 患者分为两组：两组髂总动脉直径均<18mm，以及至少有一支髂总动脉扩张（CIA≥18mm）。排除有髂外动脉意向性着陆区的患者。主要结局为生存率和免于再次干预的自由率。次要终点为 EVAR 失败、髂内相关内漏和髂内再干预。
2000 年至 2015 年，648 例患者纳入本研究，其中 277 例（43%）至少有一支 CIA≥18mm。两组患者术前危险因素相似，但慢性肾功能不全（p=0.010）和脑血管事件（p=0.040）除外，这些在髂总动脉扩张组更高。在初次手术 30 天时，扩张性髂内动脉患者的 Ib 型内漏发生率更高（p=0.020）。在平均 74.8 个月的随访中，证实了扩张性髂内动脉患者迟发性 Ib 型内漏发生率的统计学显著增加（p=0.01）。CIA≥18mm 的患者需要进行髂内相关再次干预的可能性更高（比值比 1.94；95%置信区间 1.1-3.2）。
扩张的髂总动脉被认为是 EVAR 的合适着陆区，尽管随着时间的推移，二次干预的风险增加，主要是由于髂总动脉扩张和继发性 Ib 型内漏。接受带有喇叭状髂内分支的 EVAR 的患者可能受益于更密集的监测，以避免晚期失败。
