Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Department of Surgery, Division of Vascular Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Langenbecks Arch Surg. 2024 Apr 23;409(1):135. doi: 10.1007/s00423-024-03326-8.
Endovascular repair is the preferred treatment for aortoiliac aneurysm, with preservation of at least one internal iliac artery recommended. This study aimed to assess pre-endovascular repair anatomical characteristics of aortoiliac aneurysm in patients from the Global Iliac Branch Study (GIBS, NCT05607277) to enhance selection criteria for iliac branch devices (IBD) and improve long-term outcomes.
Pre-treatment CT scans of 297 GIBS patients undergoing endovascular aneurysm repair were analyzed. Measurements included total iliac artery length, common iliac artery length, tortuosity index, common iliac artery splay angle, internal iliac artery stenosis, calcification score, and diameters in the device's landing zone. Statistical tests assessed differences in anatomical measurements and IBD-mediated internal iliac artery preservation.
Left total iliac artery length was shorter than right (6.7 mm, P = .0019); right common iliac artery less tortuous (P = .0145). Males exhibited greater tortuosity in the left total iliac artery (P = .0475) and larger diameter in left internal iliac artery's landing zone (P = .0453). Preservation was more common on right (158 unilateral, 34 bilateral) than left (105 unilateral, 34 bilateral). There were 192 right-sided and 139 left-sided IBDs, with 318 IBDs in males and 13 in females.
This study provides comprehensive pre-treatment iliac anatomy analysis in patients undergoing endovascular repair with IBDs, highlighting differences between sides and sexes. These findings could refine patient selection for IBD placement, potentially enhancing outcomes in aortoiliac aneurysm treatment. However, the limited number of females in the study underscores the need for further research to generalize findings across genders.
血管腔内修复是治疗主髂动脉瘤的首选方法，建议至少保留一侧髂内动脉。本研究旨在评估全球髂支研究（GIBS，NCT05607277）中接受血管内动脉瘤修复的患者的主髂动脉瘤血管腔内修复前的解剖特征，以增强髂分支装置（IBD）的选择标准，并改善长期结果。
对 297 例接受血管内动脉瘤修复的 GIBS 患者的治疗前 CT 扫描进行了分析。测量包括总髂动脉长度、髂总动脉长度、迂曲指数、髂总动脉分叉角、髂内动脉狭窄、钙化评分以及装置着陆区的直径。统计检验评估了解剖学测量和 IBD 介导的髂内动脉保留的差异。
左总髂动脉长度短于右（6.7mm，P=0.0019）；右髂总动脉迂曲程度较低（P=0.0145）。男性左总髂动脉迂曲程度更大（P=0.0475），左髂内动脉着陆区直径更大（P=0.0453）。右侧（158 例单侧，34 例双侧）比左侧（105 例单侧，34 例双侧）更常见保留。右侧有 192 个 IBD，左侧有 139 个 IBD，男性 318 个，女性 13 个。
本研究提供了接受 IBD 血管内修复的患者术前髂内解剖分析的综合资料，突出了两侧和性别之间的差异。这些发现可以改进 IBD 放置的患者选择，有可能提高主髂动脉瘤治疗的效果。然而，研究中女性数量有限，突出了需要进一步研究以在性别之间推广研究结果。
