Koussayer Bilal, Zaidan Louai, Atassi Anas, Khalil Bassam, Koussayer Samer
University of South Florida Health Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA.
Al Faisal University, College of Medicine, Riyadh, Saudi Arabia.
Surg Pract Sci. 2023 Aug 13;14:100208. doi: 10.1016/j.sipas.2023.100208. eCollection 2023 Sep.
The current gold standard of treatment aortoiliac aneurysms are through endovascular aneurysm repairs which can result in occluding the internal iliac artery. An alternative that preserves internal iliac artery blood flow is the sandwich technique. This is when two covered stents of the internal and external iliac arteries are placed inside the main limb of common iliac artery stent. The complexity of such task is complicated by efficiently calculating the size of the stent grafts to ensure a proper fit.
We have developed a mathematical proof that depends on the arterial circumferences to size the three stents needed for the sandwich technique: . D is the diameter of the common iliac stent, d and d is the diameter of the internal and external iliac artery stent. We added 2 mm to account for the thickness of stents.
We have treated 10 common iliac artery aneurysms using this formula. Patients were followed up by CTA scans three, six and twelve months after the procedure. Seven of ten had complete sealing and no type III endoleaks intraoperatively. The other three had a small, limited type III endoleak at completion angiogram, that disappeared completely on the three months follow-up. At one-year follow up only one patient developed moderate claudication and erectile dysfunction.
ST is considered a practical and feasible approach, as it is easy to implement and can be utilized in most cases, especially in emergencies. It is also cost effective due the use of standard grafts without the need for specialized stents. Our aiming by improving this surgical technique is that we will be able to help standardize practice leading to reduced waste, maintain longer-term repair and therefore reduce complication risks.
目前治疗主-髂动脉瘤的金标准是通过血管内动脉瘤修复术，这可能会导致髂内动脉闭塞。一种保留髂内动脉血流的替代方法是三明治技术。即在内、外髂动脉放置两个覆膜支架，置于髂总动脉支架的主支内。有效计算支架移植物的尺寸以确保合适的贴合度，使这项任务变得复杂。
我们已经推导出一种数学证明，该证明依据动脉周长来确定三明治技术所需的三个支架的尺寸： 。D是髂总动脉支架的直径，d和d分别是髂内和髂外动脉支架的直径。我们增加2毫米以考虑支架的厚度。
我们使用这个公式治疗了10例髂总动脉动脉瘤。术后3个月、6个月和12个月通过CTA扫描对患者进行随访。10例中有7例术中完全封闭且无III型内漏。另外3例在完成血管造影时出现小的、局限性III型内漏，在3个月随访时完全消失。在1年随访时，只有1例患者出现中度跛行和勃起功能障碍。
三明治技术被认为是一种实用且可行的方法，因为它易于实施，可在大多数情况下使用，尤其是在紧急情况下。由于使用标准移植物而无需特殊支架，它还具有成本效益。我们改进这种手术技术的目的是能够帮助规范操作，减少浪费，维持长期修复，从而降低并发症风险。
