Xu Huichao, Fan Hua, Li Yubin, Zhang Heng, Zhao Zhenyuan, Li Lin, Liu Mingyuan, Liu Junjun, Guo Mingjin
Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Shandong, China.
Department of Vascular Surgery, Linyi Peoples' Hospital, Shandong, China.
Sci Prog. 2025 Apr-Jun;108(2):368504251353580. doi: 10.1177/00368504251353580. Epub 2025 Jun 25.
ObjectiveThe aim of study is to investigate the safety and efficacy of preserving bilateral internal iliac arteries (IIAs) in patients with aortoiliac aneurysms using iliac branch stent grafts (IBSG).MethodsFrom June 2019 to February 2024, a total of 265 patients with aortoiliac aneurysm from four tertiary hospitals in China were included. They were divided into 110 patients with bilateral iliac artery aneurysms and 155 patients with unilateral aneurysm. Based on whether the IIA were occluded, the patients with bilateral aneurysms were further divided into Group BB (bilateral aneurysms with bilateral IBSG) and Group BU (bilateral aneurysms with unilateral IBSG and contralateral IIA embolization), and the patients with unilateral aneurysm into Group UB (unilateral aneurysm and preserve bilateral IIA) and Group UU (unilateral aneurysm and preserve unilateral IIA). Group BB and Group BU, as well as Group UB and Group UU, were compared after propensity score matching. The primary endpoint was major adverse events, and the secondary endpoint was pelvic ischemia.ResultsAfter matching, there were 76 patients in the Group BB (38 patients) and the Group BU (38 patients), with an average follow-up of 24.0 ± 7.0 months. Among these patients, 3 patients (7.9%) in the Group BB and 2 patients (5.3%) in the Group BU experienced IBSG occlusion. In the Group BB, 1 patient (2.6%) had type IB endoleak, 1 patient (2.6%) had type III endoleak due to IBSG migration, and 1 patient (2.6%) in the Group BU had type I endoleak. The rate of IBSG-related interventions was similar between the two groups (13.2% vs. 7.9%, > 0.05). Compared with the Group BB, patients with buttock claudication (1 vs. 10, < 0.05) and decreased erection function (2 vs. 12, < 0.05) were more common in the Group BU, and the Group BU also reported more new cases of erectile dysfunction (1 vs. 6, < 0.05). After matching, there were 55 patients in the Group UB and 55 patients in the Group UU, with an average follow-up of 23.0 ± 6.0 months. One patient (1.8%) in the Group UB and 1 patient (1.8%) in the Group UU experienced type I endoleak. Four patients (7.3%) in the Group UB and 1 patient (1.8%) in the Group UU underwent reintervention ( > 0.05). One patient (1.8%) in the Group UB and 13 patients (23.6%) in the Group UU complained of buttock claudication, and more patients in the Group UU had decreased erection function (2 vs. 14, < 0.05). Among these, 9 patients (16.4%) had newly developed erectile dysfunction ( < 0.05). During the study period, no patients experienced aneurysm-related mortality.ConclusionThe complete preservation of bilateral IIAs using IBSG has shown satisfactory midterm results, which are associated with lower rates of occlusion and reintervention. Additionally, the strategy may effectively preserve the ambulation and sexual function of patients.
本研究旨在探讨使用髂支支架移植物（IBSG）保留腹主动脉髂动脉瘤患者双侧髂内动脉（IIA）的安全性和有效性。
2019年6月至2024年2月，纳入中国4家三级医院的265例腹主动脉髂动脉瘤患者。他们被分为110例双侧髂动脉瘤患者和155例单侧动脉瘤患者。根据IIA是否闭塞，双侧动脉瘤患者进一步分为BB组（双侧动脉瘤采用双侧IBSG）和BU组（双侧动脉瘤采用单侧IBSG及对侧IIA栓塞），单侧动脉瘤患者分为UB组（单侧动脉瘤并保留双侧IIA）和UU组（单侧动脉瘤并保留单侧IIA）。倾向得分匹配后，对BB组和BU组以及UB组和UU组进行比较。主要终点是主要不良事件，次要终点是盆腔缺血。
匹配后，BB组（38例）和BU组（38例）各有76例患者，平均随访24.0±7.0个月。在这些患者中，BB组3例（7.9%）、BU组2例（5.3%）发生IBSG闭塞。BB组中，1例（2.6%）发生IB型内漏，1例（2.6%）因IBSG移位发生III型内漏，BU组1例（2.6%）发生I型内漏。两组IBSG相关干预率相似（13.2%对7.9%，P>0.05）。与BB组相比，BU组患者臀部间歇性跛行（1例对10例，P<0.05）和勃起功能减退（2例对12例，P<0.05）更为常见，且BU组勃起功能障碍新发病例更多（1例对6例，P<0.05）。匹配后，UB组和UU组各有55例患者，平均随访23.0±6.0个月。UB组1例（1.8%）、UU组1例（1.8%）发生I型内漏。UB组4例（7.3%）、UU组1例（1.8%）接受再次干预（P>0.05）。UB组1例（1.8%）、UU组13例（23.6%）主诉臀部间歇性跛行，UU组更多患者有勃起功能减退（2例对14例，P<0.05）。其中，9例（16.4%）有新发勃起功能障碍（P<0.05）。研究期间，无患者发生动脉瘤相关死亡。
使用IBSG完全保留双侧IIA显示出令人满意的中期结果，其闭塞率和再次干预率较低。此外，该策略可有效保留患者的行走和性功能。
