Kim Choshin, Park Yang-Jin, Park Joon-Kee, Kim Young-Wook, Kim Dong-Ik, Yang Shin-Seok, Park Taek Kyu, Choi Seung-Hyuk
Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea.
Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Vascular. 2025 Aug;33(4):796-802. doi: 10.1177/17085381241273140. Epub 2024 Aug 8.
ObjectivesThis study aimed to evaluate the outcomes and anatomical predictors of the complications of flared limb (FL) use for ectatic common iliac arteries accompanied by abdominal aortic aneurysm treated with endovascular aneurysm repair (EVAR).MethodsIn this single-center retrospective study, we reviewed data from 391 patients (638 limbs) treated between 2005 and 2020. The cohort was divided into two groups. The standard limbs (SLs, = 403) included stent graft (SG) of <20 mm in diameter and the FLs ( = 235) included stent graft of ≥20 mm in diameter. Complications within 30 days were investigated as the short-term outcome. Limb events during follow-up including type Ib endoleak (EL), type IIIa EL, and limb occlusion were compared between SLs and FLs using log-rank test.ResultsEarly results indicated that the FL group had a significantly higher incidence of intraoperative type Ib EL at 5.1% (12), than 1.7% (7) in the SLs ( = .016). For 19 patients in whom intraoperative type Ib EL was discovered, SG extension alone or internal iliac artery embolization was all performed before completing the procedure. Overall, we noted one case of type Ib EL and two cases of limb events in each group at 30 days. Over a median follow-up of 39 months, 31 (4.9%) events (17 type Ib EL, 2 type IIIa EL, and 12 limb events), 13 (5.5%) in FLs and 18 (4.5%) in SLs ( = .984), were observed. The FLs had significantly higher rates of aortic sac enlargement, with 46 (19.6%) cases for FLs and 36 (8.9%) for SLs ( < .001). The Kaplan-Meier analysis revealed significant differences at 5 years in SLs versus FLs for freedom from type Ib EL (96.6% vs 82.4%, respectively; < .001) and no difference in freedom from limb events (94.7% vs 84.5%, respectively; = .519). Furthermore, no difference was observed for overall survival and aneurysm-related mortality.ConclusionsAlthough an FL for EVAR is used to treat dilated iliac arteries, there is an increased risk of intraoperative and late type Ib EL and aortic sac enlargement. Long-term close follow-up is mandatory, especially in the patients who undergo EVAR using FLs.
目的
本研究旨在评估用于伴有腹主动脉瘤的扩张性髂总动脉的喇叭形肢体（FL）在血管腔内修复术（EVAR）治疗中的并发症结局及解剖学预测因素。
方法
在这项单中心回顾性研究中，我们回顾了2005年至2020年间接受治疗的391例患者（638条肢体）的数据。该队列分为两组。标准肢体（SLs，n = 403）包括直径<20 mm的支架型人工血管（SG），FLs（n = 235）包括直径≥20 mm的支架型人工血管。将30天内的并发症作为短期结局进行研究。使用对数秩检验比较SLs和FLs随访期间的肢体事件，包括Ib型内漏（EL）、IIIa型EL和肢体闭塞。
结果
早期结果表明，FL组术中Ib型EL的发生率显著高于SLs组，分别为5.1%（12例）和1.7%（7例）（P = 0.016）。对于19例术中发现Ib型EL的患者，在完成手术前均单独进行了SG延伸或髂内动脉栓塞。总体而言，我们注意到两组在30天时各有1例Ib型EL和2例肢体事件。在中位随访39个月期间，观察到31例（4.9%）事件（17例Ib型EL、2例IIIa型EL和12例肢体事件），FLs组13例（5.5%），SLs组18例（4.5%）（P = 0.984）。FLs组主动脉瘤囊扩大的发生率显著更高，FLs组有46例（19.6%），SLs组有36例（8.9%）（P < 0.001）。Kaplan-Meier分析显示，SLs和FLs在5年时免于Ib型EL的情况有显著差异（分别为96.6%和82.4%；P < 0.001），而免于肢体事件的情况无差异（分别为94.7%和84.5%；P = 0.519）。此外，总体生存率和动脉瘤相关死亡率无差异。
结论
尽管EVAR使用FL治疗扩张性髂动脉，但术中及晚期Ib型EL和主动脉瘤囊扩大的风险增加。必须进行长期密切随访，尤其是对于接受使用FLs的EVAR治疗的患者。
