带髂内分支支架的腔内隔绝术治疗腹主动脉瘤伴双髂动脉瘤

目的探讨带髂内分支支架的腔内隔绝技术在腹主动脉瘤伴双髂动脉瘤治疗中的应用。方法回顾性分析2011年6月～2012年6月我院收治的10例腹主动脉瘤合并双髂动脉瘤患者的临床资料。患者均于术前行CT血管造影(CTA)检查,腹主动脉瘤均为肾下型;髂动脉瘤仅累及髂总动脉8例,累及髂内动脉开口处2例。手术先置入带髂内分支的髂动脉带膜支架,再置入腹主动脉瘤的分叉型带膜支架。结果患者均一次手术成功,无死亡。9例患者获得随访,随访时间3～6个月,患者腹部搏动性肿块均消失,均未出现臀部、骶尾部坏死,无明显性功能障碍,1例出现臀部的轻度间歇性跛行。8例术后3个月行腹主、双髂动脉彩超检查,未见明显内瘘,移植的髂内分支支架血流通畅。3例术后6个月行腹主、双髂动脉CTA检查,未见Ⅰ型、Ⅲ型内瘘,髂内分支支架内血流通畅。结论带髂内分支支架的腔内隔绝技术在腹主动脉瘤伴双髂动脉瘤的治疗中是安全、有效的;可以有效地保留一侧髂内动脉,减少或避免因髂内动脉封闭而带来的并发症。

The use of iliac branch device for endovascular exclusion in the treatment of aortic and bilateral iliac artery aneurysms

Objective To research the use of iliac branch device (IBD) for endovascular exclusion in the treatment of aortic and bilateral iliac aneurysms. Methods From Jun. 2011 to Jun. 2012, the data of 10 patients with aortoiliac artery aneurysms were analyzed retrospectively. All cases were infrarenal abdominal aortic aneurysm involving common iliac artery (CIA)(n=8) and internal iliac artery (IIA)ostia (n=2), which were confirmed by computed tomography angiography (CTA) before operation. The abdominal aortic branched grafts were implanted after the iliac branched endograft. Results All the patients were succesfully operated once without death. Nine patients were followed up with a time of 3～6 months. During the follow-up time, buttock claudication developed in 1 case, but no necrosis of sacrococcygeal region and the buttocks or sexual dysfunction occurred. No endoleaks and blood flowing of the iliac branched endograft were observed in 8 cases at 3-month postoperatively by color Doppler ultrasonography and in 3 cases at 6-month postoperatively by CTA. Conclusion It is safe and effective for endovascular exclusion using of branched endograft for aortoiliac artery aneurysms. It can conserve one side IIA to reduce or avoid the complications caused by the occlusion of both IIA.