Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Departments of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China; Eight-year Program of Clinical Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Ann Vasc Surg. 2023 Apr;91:117-126. doi: 10.1016/j.avsg.2022.11.013. Epub 2022 Dec 8.
During endovascular aneurysm repair (EVAR), commercial iliac branch devices (IBDs) have become an inescapable alternative for preserving antegrade internal iliac artery (IIA) blood flow. Due to the different morphological features of aneurysms, commercial IBDs may not be suitable for all patients. Reported experience with the implantation of the new surgeon-modified IBD (sm IBD) is limited. This investigation describes the indications, efficacy, and safety of the sm IBD.
Data from consecutive elective implantations of IBDs in patients between March 2011 and May 2021 in a single center were incorporated. The sm IBDs were indicated in patients with common iliac artery aneurysms (CIAAs) and with a challenging anatomy and in those patients with or without abdominal aortic aneurysm (AAA).
Fifteen patients (15 male, mean age 67.6 ± 7.9 years) were included. Fifteen sm IBDs were implanted in 1 procedure (100%). Fourteen (93.3%) patients had simultaneous endovascular aneurysm repair (EVAR) and 1 (6.7%) patient previously had a bilateral CIAAs repair by EVAR. The mean common iliac artery (CIA) diameter was 36.6 ± 12.5 mm. Technical success was obtained in all patients (100%). The median operation time was 189.7 ± 78.6 min, with a median fluoroscopy time of 45.3 ± 15.9 min. Axillary artery access was used in 11 (73.3%) procedures. The mean total hospital stay was 5.6 ± 2.8 days, and the postoperative follow-up was 35.4 months (range 2-120). The estimated IIA bridge stent patency at 1 year after operation was 100% and 85.7% ± 13.2% 5 years postoperatively. One (6.7%) IIA branch was occluded, and this patient remained asymptomatic. One patient (6.7%) needed reintervention, and another (6.7%) patient had type II leakage, which is currently under close surveillance.
Using an IBD to maintain the pelvic blood flow is an effective and feasible intravascular technique, especially for patients with an abnormal iliac artery anatomy. This novel technique has similar midterm procedural success rate compared to the use of commercial IBDs. Therefore, these devices are more suitable for patients with certain anatomic challenges and can be used as an alternative treatment.
在血管内动脉瘤修复术（EVAR）期间，商业髂分支装置（IBD）已成为保留顺行髂内动脉（IIA）血流的必然选择。由于动脉瘤的形态特征不同，商业 IBD 可能并不适合所有患者。关于新型外科医生改良髂分支装置（sm IBD）的植入经验报告有限。本研究描述了 sm IBD 的适应证、疗效和安全性。
纳入 2011 年 3 月至 2021 年 5 月期间在一家中心连续进行的 IBD 植入术的连续患者数据。在髂动脉瘤（CIAAs）和具有挑战性的解剖结构的患者中，以及在有或没有腹主动脉瘤（AAA）的患者中，均采用 sm IBD。
共纳入 15 例患者（15 例男性，平均年龄 67.6±7.9 岁）。1 例患者（100%）在 1 次手术中植入 15 个 sm IBD。14 例（93.3%）患者同时行血管内动脉瘤修复术（EVAR），1 例（6.7%）患者先前行双侧 CIAAs EVAR 修复术。平均髂总动脉（CIA）直径为 36.6±12.5mm。所有患者均获得技术成功（100%）。中位手术时间为 189.7±78.6 分钟，中位透视时间为 45.3±15.9 分钟。11 例（73.3%）采用腋动脉入路。平均总住院时间为 5.6±2.8 天，术后随访 35.4 个月（范围 2-120）。术后 1 年 IIA 桥支架通畅率估计为 100%，术后 5 年为 85.7%±13.2%。1 例（6.7%）IIA 分支闭塞，该患者无症状。1 例（6.7%）需要再次干预，另 1 例（6.7%）患者出现 II 型漏，目前正在密切监测。
使用 IBD 维持盆腔血流是一种有效且可行的血管内技术，特别适用于髂动脉解剖异常的患者。与使用商业 IBD 相比，这种新技术具有相似的中期手术成功率。因此，这些装置更适合具有特定解剖挑战的患者，可作为替代治疗方法。
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