Department of Surgery - Vascular Surgery Unit, School of Medicine, University of Ioannina, Ioannina, Greece; Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
Ann Vasc Surg. 2021 Jul;74:497-501. doi: 10.1016/j.avsg.2021.02.021. Epub 2021 Apr 2.
Preservation of the hypogastric circulation is of major clinical importance in cases of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA). Pelvic ischemia can be detrimental and significantly increase post-operative morbidity and mortality. However, the application of a side branch device or a bell-bottom graft is not possible in ruptured aortoiliac aneurysms (due to off-the-shelf unavailability and/or prolonged operative time) and in most cases pelvic circulation may have to be sacrificed. We report a case of a rAAA with bilateral common iliac artery (CIA) aneurysms that was successfully repaired with an aorto-uni-iliac (AUI) endograft, a cross-femoral bypass, and an inverted-U shaped contralateral EIA to IIA endovascular bypass. The procedure is described in detail and certain technical points are further discussed. The steps in cases where the aneurysm has ruptured are different compared to elective repairs and vascular surgeons need to be aware of certain pitfalls. This strategy may be feasible in the acute setting and permits preservation of the hypogastric circulation with the combination of standard techniques and grafts that are readily available in most institutions.
在腹主动脉瘤破裂（rAAA）的血管内动脉瘤修复（EVAR）中，保护下腹循环具有重要的临床意义。骨盆缺血可能有害，并显著增加术后发病率和死亡率。然而，在破裂的腹主动脉-髂动脉瘤（由于现货不可用和/或手术时间延长）中，不可能应用分支装置或喇叭形移植物，并且在大多数情况下，骨盆循环可能不得不被牺牲。我们报告了一例 rAAA 合并双侧髂总动脉（CIA）动脉瘤的病例，该病例成功地使用了腹主动脉-单髂动脉（AUI）移植物、股-股旁路和反向 U 形对侧 EIA 至 IIA 血管内旁路进行了修复。详细描述了该手术过程，并进一步讨论了某些技术要点。与择期修复相比，破裂病例的步骤不同，血管外科医生需要注意某些陷阱。在急性情况下，这种策略可能是可行的，并允许结合大多数机构都能提供的标准技术和移植物来保护下腹循环。
