Wang Lunchang, Shu Chang, Li Quanming, Li Ming, He Hao, Li Xin, Shi Yin, Qiu Jian, Wang Tun, Yang Chenzi, Wang Mo, Li Jiehua, Wang Hui, Sun Likun
Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
Vascular Disease Institute of Central South University, Changsha, China.
Front Cardiovasc Med. 2021 Oct 18;8:745250. doi: 10.3389/fcvm.2021.745250. eCollection 2021.
To report a novel common-iliac-artery skirt technology (CST) in treating challenge iliac artery aneurysms. When required healthy landing zone of common iliac artery (CIA) is not available, CST is a strategy to exclude the internal iliac artery (IIA) and prevent IIA reflux without need of embolization. Patients who received endovascular aneurysm repair (EVAR) in our center from 2014 to 2020 were retrospectively screened, and patients treated with CST or with IIA embolization (IIAE) were enrolled. After retrospective screen of 524 EVAR patients, 39 CST patients, 26 IIAE patients, and 7 CST + IIAE patients were enrolled in this study. CST group suggested to have more aged, hyperlipemia, and smoking patients than IIAE group. Two groups had comparable maximal diameter of abdominal aorta (AA), CIA, EIA, but larger diameter of IIA (CST 19.82 ± 2.281 vs. IIAE 27.82 ± 3.401, = 0.048), and CIA bifurcation (CST 25.01 ± 1.316 vs. IIAE 29.76 ± 2.775, = 0.087) was found in IIAE group. Anatomy of 79.5% of CST patients and 92.3% of IIAE patients ( = 0.293) was not suitable for potential use of iliac branch device. CST group had significant shorter surgery time (CST 97.42 ± 3.891 vs. IIAE 141.0 ± 8.010, < 0.001), shorter hospital stay (CST 15.35 ± 0.873 vs. IIAE 19.32 ± 1.067, = 0.009), lower in-hospital [CST 0% (0/39) vs. IIAE 11.5% (3/26), = 0.059] and 1-year follow-up stent related MAEs [CST 6.7% (2/30) vs. IIAE 28.6% (6/21), = 0.052], but comparable mortality and stent related MAEs for all-cohort follow-up analysis comparing to IIAE group. In our study, a lower in-hospital buttock claudication (BC) rate for CST (CST 20.5% vs. IIAE 46.2%, = 0.053) and a comparable erectile dysfunction (ED) rate (CST 10.3% vs. IIAE 23.1%, = 0.352) were found between CST and IIAE groups. After 1 year, both groups had about one third relief of BC symptoms [CST 33.3% (4/12) vs. IIAE 30.7% (4/13), = 1.000]. Subgroup analysis of 14 patents concomitant with IIA aneurysm in CST group and the 7 CST + IIAE patients were carried out, and no difference was found in mortality, stent MAEs, sac dilation, or reintervention rate. Last, illustration of seven typical CST cases was presented. In selected cases, the CST is a safe, feasible-and-effective choose in treating challenge iliac artery aneurysms and preventing IIA endoleak.
报告一种新型的髂总动脉裙边技术（CST）用于治疗具有挑战性的髂动脉动脉瘤。当髂总动脉（CIA）所需的健康着陆区不可用时，CST是一种无需栓塞即可排除髂内动脉（IIA）并防止IIA反流的策略。对2014年至2020年在我们中心接受血管内动脉瘤修复（EVAR）的患者进行回顾性筛查，纳入接受CST或IIA栓塞（IIAE）治疗的患者。在对524例EVAR患者进行回顾性筛查后，本研究纳入了39例CST患者、26例IIAE患者和7例CST + IIAE患者。CST组的老年、高脂血症和吸烟患者似乎比IIAE组更多。两组的腹主动脉（AA）、CIA、股动脉（EIA）最大直径相当，但IIAE组的IIA直径更大（CST 19.82±2.281 vs. IIAE 27.82±3.401，P = 0.048），且CIA分叉处更大（CST 25.01±1.316 vs. IIAE 29.76±2.775，P = 0.087）。79.5%的CST患者和92.3%的IIAE患者的解剖结构（P = 0.293）不适合潜在使用髂支装置。CST组的手术时间明显更短（CST 97.42±3.891 vs. IIAE 141.0±8.010，P < 0.001），住院时间更短（CST 15.35±0.873 vs. IIAE 19.32±1.067，P = 0.009），住院期间（CST 0%（0/39）vs. IIAE 11.5%（3/26），P = 0.059）和1年随访时支架相关的主要不良事件（MAEs）更低（CST 6.7%（2/30）vs. IIAE 28.6%（6/21），P = 0.052），但与IIAE组相比，全队列随访分析的死亡率和支架相关MAEs相当。在我们的研究中，发现CST组的住院期间臀部跛行（BC）发生率较低（CST 20.5% vs. IIAE 46.2%，P = 0.053），勃起功能障碍（ED）发生率相当（CST 10.3% vs. IIAE 23.1%，P = 0.352）。1年后，两组的BC症状缓解率均约为三分之一（CST 33.3%（4/12）vs. IIAE 30.7%（4/13），P = 1.000）。对CST组中14例合并IIA动脉瘤的患者和7例CST + IIAE患者进行亚组分析，未发现死亡率、支架MAEs、瘤囊扩张或再次干预率有差异。最后，展示了7例典型的CST病例。在选定的病例中，CST是治疗具有挑战性的髂动脉动脉瘤和预防IIA内漏的一种安全、可行且有效的选择。
