Oishi Atsumi, Matsushita Satoshi, Dohi Shizuyuki, Yamamoto Taira, Kajimoto Kan, Amano Atsushi
Department of Cardiovascular Surgery, Faculty of Medicine, School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Surg Pract Sci. 2022 Oct 25;11:100141. doi: 10.1016/j.sipas.2022.100141. eCollection 2022 Dec.
This study aimed to retrospectively determine the association between aortic dilatation and common iliac artery neck size.
Consecutive patients who had undergone elective endovascular aneurysm repair for iliac artery aneurysms (IAAs) from January 2009 to December 2017 were evaluated.
Aneurysm dilatations >3 mm were observed in five cases; two cases were LAND+ and three cases were LAND-. Radiological analysis revealed that type 1 and type 2 endoleaks caused dilatations in all cases. In LAND+ cases, endoleaks occurred due to blood inflow from the distal side of the aneurysm due to coil embolization failure, whereas in LAND- cases, endoleaks occurred due to retrograde inflow from the distal side of the internal iliac artery (IIA) and antegrade inflow from the lumbar artery. Decreased IAA diameters were significantly more common in the LAND+ group than in the LAND- group.
Endoleaks are the major cause of postoperative dilatation in IAA. The neck size of the common iliac artery was determined to be a crucial factor contributing to postoperative dilation of IAA. Radiological analysis revealed that the endoleaks in the IIA and lumbar artery were responsible for dilatation in all cases.
When the portion of the common iliac artery from the terminal aorta to the IAA was <16 mm in diameter, postoperative aneurysms decreased.
本研究旨在回顾性确定主动脉扩张与髂总动脉颈部尺寸之间的关联。
对2009年1月至2017年12月期间因髂动脉瘤（IAA）接受择期血管内动脉瘤修复术的连续患者进行评估。
观察到5例动脉瘤扩张>3 mm；2例为LAND+，3例为LAND-。影像学分析显示，所有病例中1型和2型内漏均导致扩张。在LAND+病例中，内漏是由于弹簧圈栓塞失败导致血液从动脉瘤远端流入所致，而在LAND-病例中，内漏是由于来自髂内动脉（IIA）远端的逆行血流和来自腰动脉的顺行血流所致。LAND+组中IAA直径减小的情况明显比LAND-组更常见。
内漏是IAA术后扩张的主要原因。髂总动脉的颈部尺寸被确定为导致IAA术后扩张的关键因素。影像学分析显示，IIA和腰动脉的内漏在所有病例中均导致扩张。
当从主动脉末端到IAA的髂总动脉部分直径<16 mm时，术后动脉瘤缩小。
