国人腹主动脉瘤累及髂动脉的解剖学特征与髂动脉分支支架适用性：单中心58例分析

目的:通过单中心临床调查,分析腹主动脉瘤(AAA)累及髂动脉国人患者的髂动脉解剖学特点与髂动脉分支支架(IBD)适用性的关系。方法:回顾性分析2015年7月—2017年3月复旦大学附属中山医院血管外科58例累及双侧或单侧髂总动脉的AAA患者,利用3D工作站分析其影像学资料,并进行相关数据测量分析,结合基于解剖特点的使用标准,分析两款IBD(Cook IBD,Gore IBE)在患者中的适用性及其限制因素。结果:58例AAA患中,49例累及双侧髂总动脉,9例累及单侧髂总动脉。病变髂总动脉的平均长度分别为左侧(57.9±18.1)mm,右侧(56.7±17.4)mm,平均最大直径分别为左侧(17.7±7.2)mm,右侧(25.1±9.4)mm。根据两款支架使用标准,Cook IBD与Gore IBE治疗病变髂动脉的适用比率分别为26.1%(28/107)、20.6%(22/107)。Cook IBD最主要的限制因素是髂内动脉直径6或9 mm(50/107,46.7%);Gore IBE最主要的限制因素是髂总动脉直径25 mm(67/107,62.6%)。结论:基于解剖标准的IBD在AAA累及髂动脉国人患者中适用性较低,髂总动脉和髂内动脉直径的不符合是其主要限制因素。

Anatomic features in Chinese patients with abdominal aortic aneurysms involving iliac arteries and applicability of iliac branch devices: an analysis of 58 cases in a single center

Objective: To analyze the relationship between the anatomic features of the iliac arteries in Chinese patients with abdominal aortic aneurysms (AAA) involving the iliac arteries and the applicability of iliac branch devices (IBDs) through a single-center clinical investigation. Methods: The clinical data of 58 patients with AAA involving bilateral or unilateral iliac arteries admitted in the Department of Vascular Surgery of Affiliated Zhongshan Hospital, Fudan University from July 2015 to March 2017 were reviewed. The imaging data of the patients were analyzed using a three-dimensional workstation, and the relevant variables were measured. According to the instructions for use based on anatomic distinctions, the applicability of two types of IBDs (Cook IBD, Gore IBE) among these patients and their restricting factors were analyzed.Results: Of 58 AAA patients, bilateral common iliac arteries were affected in 49 cases and unilateral common iliac artery was affected in 9 cases. The mean length of affected common iliac artery was (57.9±18.1) mm for the left common iliac artery and (56.7±17.4) mm for the right common iliac artery, with the mean diameter of (17.7±7.2) mm for the left common iliac artery and (25.1±9.4) mm for the right common iliac artery, respectively. Based on the instructions for use of the two types of IBDs, the ratio of applicability in the affected iliac arteries was 26.1% (28/107) for Cook IBD and 20.6% (22/107) for Gore IBE. The main restricting factor for Cook IBD was the diameter of the internal iliac artery9 mm (50/107, 46.7%), and the most common reason for exclusion from Gore IBE was the diameter of the common iliac artery <25 mm (67/107, 62.6%).Conclusion: The applicability of anatomic criteria-based IBDs in Chinese patients with AAA aneurysms involving the iliac arteries is relatively low. The unconformities in the diameters of the common iliac artery and internal iliac artery are the main restricting factors for their use.