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髂颈部扩张导致先前接受血管内腹主动脉瘤修复治疗的腹主动脉瘤破裂。

Iliac neck dilatation causes rupture of abdominal aortic aneurysm previously treated with endovascular aortic aneurysm repair.

作者信息

Fuchigami Maki, Ogawa Yukihisa, Chiba Kiyoshi, Komagamine Masahide, Nawata Shintaro, Kinebuchi Satoshi, Mimura Hidefumi, Miyairi Takeshi, Nishimaki Hiroshi

机构信息

Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.

Department of Radiology, Tokai University School of Medicine Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan.

出版信息

Radiol Case Rep. 2023 Oct 12;18(12):4485-4488. doi: 10.1016/j.radcr.2023.09.056. eCollection 2023 Dec.

DOI:10.1016/j.radcr.2023.09.056
PMID:37868009
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10589737/
Abstract

A 78-year-old male had undergone endovascular aortic aneurysm repair (EVAR) 7 years prior to presentation. Although the sac was stable 6 months ago, the patient presented with shock at arrival, and CT showed aortic rupture with rapid expansion due to type Ib endoleak caused by iliac neck dilatation (IND). The aneurysm sac was excluded using an endovascular strategy. Bell-bottom iliac limbs can cause IND associated with type Ib endoleak. Additionally, the risk of rupture is high when re-expansion of an aneurysm occurs after sac regression after EVAR. Therefore, close follow-up is mandatory for patients with IND after EVAR.

摘要

一名78岁男性在就诊前7年接受了血管内主动脉瘤修复术（EVAR）。尽管6个月前瘤腔稳定，但患者入院时出现休克，CT显示由于髂颈扩张（IND）导致Ib型内漏，主动脉破裂并迅速扩张。采用血管内策略排除了动脉瘤瘤腔。喇叭口状髂支可导致与Ib型内漏相关的IND。此外，EVAR术后瘤腔缩小后动脉瘤再次扩张时破裂风险很高。因此，EVAR术后有IND的患者必须密切随访。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb58/10589737/57df3551788c/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb58/10589737/13572d504e3d/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb58/10589737/1935772003ab/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb58/10589737/57df3551788c/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb58/10589737/13572d504e3d/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb58/10589737/1935772003ab/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cb58/10589737/57df3551788c/gr3.jpg

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本文引用的文献

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J Vasc Surg. 2022 Aug;76(2):454-460. doi: 10.1016/j.jvs.2022.01.079. Epub 2022 Jan 29.
2
Bell-bottom technique in iliac branch era: mid-term single stent graft performance.髂支时代的喇叭口技术：单枚支架型人工血管的中期性能
CVIR Endovasc. 2020 Nov 15;3(1):57. doi: 10.1186/s42155-020-00147-w.
3
Volume Change after Endovascular Treatment of Common Iliac Arteries ≥ 17 mm Diameter: Assessment of Type 1b Endoleak Risk Factors.
腹主动脉瘤腔内治疗后直径≥17mm 的瘤体体积变化：1b 型内漏风险因素评估。
Eur J Vasc Endovasc Surg. 2020 Jan;59(1):51-58. doi: 10.1016/j.ejvs.2019.06.006. Epub 2019 Nov 12.
4
EVAR with Flared Iliac Limbs has a High Risk of Late Type 1b Endoleak.带扩张髂支的腹主动脉瘤腔内修复术有较高的晚期1b型内漏风险。
Eur J Vasc Endovasc Surg. 2017 Aug;54(2):170-176. doi: 10.1016/j.ejvs.2017.05.008. Epub 2017 Jul 5.
5
Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair.血管内动脉瘤修复术后髂动脉封闭区动力学及临床后果
Eur J Vasc Endovasc Surg. 2017 Feb;53(2):185-192. doi: 10.1016/j.ejvs.2016.11.003. Epub 2016 Dec 24.
6
Family history of aortic disease predicts disease patterns and progression and is a significant influence on management strategies for patients and their relatives.家族史主动脉疾病预测疾病模式和进展，是对患者及其亲属的管理策略有重大影响。
J Vasc Surg. 2013 Sep;58(3):573-81. doi: 10.1016/j.jvs.2013.02.239. Epub 2013 Jul 1.
7
Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.欧洲血管外科学会腹主动脉瘤临床实践指南
Eur J Vasc Endovasc Surg. 2011 Jan;41 Suppl 1:S1-S58. doi: 10.1016/j.ejvs.2010.09.011.