腹主动脉瘤腔内隔绝术中髂动脉的处理

目的:总结腹主动脉瘤(AAA)行腔内隔绝术时髂动脉的处理方式。方法:2004年7月至2010年11月共对43例瘤体累及单侧或双侧髂动脉分叉的AAA行腔内隔绝术,其中单侧髂动脉分叉受累27例,双侧髂动脉分叉受累16例。根据髂动脉病变情况,分别采取髂内动脉单纯覆盖、髂内动脉栓塞后覆盖、髂动脉外环结扎、一侧髂内动脉重建等不同的处理方法。结果:所有病例均操作成功,手术结束时无Ⅰ型内漏存在。术后出现臀部间歇性跛行6例(14.0%),便血1例(2.3%),无病例发生臀部或会阴部皮肤坏死、肠坏死及死亡。结论:术中避免同时封闭双侧髂内动脉,尽量保留一侧髂内动脉是很重要的。     

腹主动脉瘤腔内隔绝术中栓塞双侧髂内动脉后右部臀肌大面积坏死1例报告

正腹主动脉瘤累及髂总动脉是腹主动脉瘤病变的常见症状之一,其中以单侧髂总动脉较常见,而双侧髂总动脉同时受累较罕见。术中需栓塞髂内动脉以防止血液反流。由于髂内动脉承担臀肌、盆腔以及脊髓等组织的血液供应,所以同时栓塞双侧髂内动脉极可能出现严重臀肌、骶尾坏死等并发症。无锡市人民医院血管外科收治1例腹主动脉瘤累及双侧髂总动脉病人,术中栓塞双侧髂内动脉后导致右侧臀肌大面积缺血坏死。现报告如下。     

自制髂动脉分支支架治疗腹主动脉瘤累及双侧髂内动脉1例

髂内动脉主要供应盆腔肌肉及部分盆腔脏器的血供.栓塞一侧髂内动脉可能导致盆肌缺血,进而引起跛行;如栓塞双侧髂内动脉,发生盆肌缺血坏死及骶骨坏死等严重并发症的可能性将增大.因此,对于双侧髂动脉瘤患者,应尽量保留一侧髂内动脉.2020年8月,我科对1例腹主动脉瘤累及双侧髂内动脉患者采用自制髂动脉分支支架( iliac bra...     

腹主动脉瘤腔内修复术后急性髂动脉血栓形成致多器官功能衰竭一例北大核心CSCD

患者男,81岁,“体检发现腹主动脉瘤1周”2014年5月21日入院.既往高血压病史.入院查体：血压152/87 mmHg,心肺腹未见异常.双侧胫后动脉、足背动脉搏动可扪及.CTA示：肾动脉下型腹主动脉瘤,累及右侧髂总动脉和双侧髂内动脉;右侧髂总起始部明显扭曲,横断面CT可见双影征（图1）.完善术前检查后,局麻下行腹主动脉瘤腔内隔绝术（endovascular aneurysm repair,EVAR）,术中见：瘤颈直径28 mm,瘤颈长22.5 mm,瘤体最大直径80 mm,右侧髂总动脉最大直径40 mm,累及右侧髂总动脉分叉部,左侧髂总动脉直径15 mm,右侧髂内动脉最大直径35 mm,左侧髂内动脉最大直径19 mm.术中切开双侧股动脉行支架植入,封闭右侧髂内动脉,保留左侧髂内动脉（图2）.     

腹主动脉瘤术中不同髂内动脉处理的疗效观察

目的：探讨腹主动脉瘤（AAA）术中结扎或是封闭髂内动脉（IIA）对患者疗效的影响。 方法：回顾性分析2010年6月—2014年6月中南大学湘雅医院手术治疗的108例AAA患者临床资料,其中腔内修复61例,开放手术44例,杂交手术3例。44例开放手术中结扎双侧IIA 7例,结扎单侧IIA 8例;61例腔内修复术中封闭双侧IIA 3例,封闭单侧IIA 5例。 结果：无术中死亡,围手术期30 d内有6例死亡均与处理IIA无关。开放手术结扎或腔内修复封闭双侧IIA的10例患者中,1例（1/10）出现直肠缺血症状,经过抗凝和扩血管治疗1个月后症状缓解;2例（2/10）出现术后一过性的臀肌疼痛,保守治疗后症状消失;均未出现间歇性跛行。开放手术结扎或是腔内修复封闭单侧IIA的13例患者中均未出现直肠缺血,臀肌疼痛或是间歇性跛行。 结论：AAA患者术中结扎或是封闭单侧IIA对患者术后状况无明显影响;结扎或是封闭双侧IIA可能出现直肠缺血或是臀肌疼痛等盆腔缺血的表现,但可经保守治疗缓解。     

经腹膜外径路行胸主动脉夹层动脉瘤腔内隔绝术

目的：探讨因股动脉狭窄无法行腔内隔绝术治疗的胸术动脉夹层动脉瘤病例的腔内微创治疗。方法：回顾性分析1998年9月至2001年12月收治的Stanford B型胸主动脉夹层动脉瘤合并双侧髂股动脉粥样硬化性狭窄的21列。结果：21例患均采用腹膜外径路显露单侧髂总动脉或腹主动脉下段，行胸主动脉夹层动脉瘤腔内隔绝术，即时操作成功率100％，结论：对于部分股动脉扭曲狭窄的患，经腹膜外径路行胸主动脉夹层动脉瘤腔内隔绝术是一条行之有效的治疗方法。     

腹主动脉瘤腔内修复术封闭髂内动脉后的初步观察

目的观察腹主动脉瘤腔内修复术(EVAR)封闭髂内动脉后臀肌和下肢缺血情况。方法回顾性分析2006年1月～2011年1月在我院行EVAR术的174例患者的临床资料。腹主动脉瘤最大直径[(55.2±12.9)mm],累及髂总动脉52例(29.9%)。EVAR治疗方法包括置入分叉型覆膜支架169例(97.1%),单臂型5例(2.9%)。术中封闭单侧髂内动脉29例,封闭双侧髂内动脉10例。观察围手术期和随访期患者臀肌和下肢发生缺血情况。结果行EVAR术的174例患者中,173例手术顺利,无中转开腹,1例术中死亡,1例术后死亡。术中封闭单侧髂内动脉29例中有2例出现同侧臀肌轻度疼痛,行走疼痛加重,跛行距离100m,5例出现同侧下肢乏力,间歇性跛行100～200m;封闭双侧髂内动脉10例中有4例术后出现臀肌轻度疼痛,跛行距离200m,均采用扩血管、祛聚保守治疗后2～4周疼痛症状好转,间歇性跛行距离均大于500m,无臀肌坏死发生,无再行介入或外科干预治疗,随访期间跛行距离逐渐增加500～1000m,余未诉特殊不适。结论 EVAR术封闭髂内动脉后臀肌和下肢不同程度缺血,经保守扩血管和祛聚治疗可以缓解,但一定程度会影响患者生活质量,封闭双侧髂内动脉或一侧均应宜慎重。     

孤立性髂动脉瘤的腔内治疗

目的探讨利用血管腔内技术治疗孤立性髂动脉瘤的安全性、可行性、有效性和存在的问题。方法自1997年5月至2006年1月,对15例孤立性髂动脉瘤患者行血管腔内治疗。真性动脉瘤12例(80％),假性动脉瘤3例(20％);髂总动脉瘤9例(60％),髂内动脉瘤3例(20％),髂外动脉瘤3例(20％)。瘤径3．5-9．0 cm,平均(5．97±1．49)cm。髂内动脉瘤采用直接栓塞技术;髂总以及髂外动脉瘤采用支架型血管腔内修复技术或结合外科手术方法及栓塞技术进行治疗。术后观察瘤腔内血液动力学改变、髂内动脉以及下肢动脉供血的改变。结果术后仅1例保留双侧髂内动脉,其余仅保留单侧。术后2例发生内漏(13％)。无围手术期死亡,无移植物错放、移位、瘤体破裂、中转手术以及由于覆盖单侧髂内动脉而引起的肠道缺血、性功能改变等并发症发生,1例术后出现一侧臀肌酸痛症状。手术时间0．5-4．0 h,平均(1．9±1．1)h;出血量30-300 ml,平均(126．7±70．1) ml;恢复活动时间0．5-4 d,平均(2．1±1．1)d;住院时间3-12 d,平均(5．5±4．7)d。结论腔内技术治疗孤立性髂动脉瘤是一种安全、可行、有效的方法。髂内动脉的处理以及内漏防治仍是困难的问题。     

腹主动脉瘤腔内修复术中特殊远端锚定区的处理经验

目的探讨腹主动脉瘤腔内修复术中特殊远端锚定区的处理方法以及并发症。方法自1997年5月至2006年12月在150例包括髂总动脉瘤、髂内动脉瘤、髂动脉狭窄、严重成角等特殊远端锚定区的腹主动脉瘤腔内修复术中,根据情况选择不同的处理方式,术后观察内漏、缺血并发症、髂动脉瘤形态以及旁路血管的通畅性。结果围手术期死亡率4％（6／150）,总死亡率42．5％（51／120）。6例原发性远端I型内漏,5例自愈,1例转化为持续性内漏;3例髂内动脉返流引起的Ⅱ型内漏随访中均自愈。7例单臂支架型血管,股股旁路手术2年通畅率为86％;4例髂内动脉旁路手术2年通畅率为100％。11例栓塞单侧髂内动脉出现臀肌缺血症状,平均症状消失时间42 d（5-90 d）。结论结合传统外科技术以及腔内技术,并选择合适的产品处理腹主动脉瘤特殊远端锚定区可取得满意疗效。中远期结果仍需观察。     

骨盆骨折出血超选择动脉栓塞的影像学基础

[目的]探讨骨盆动脉吻合的影像学特点及骨盆骨折出血超选择动脉栓塞的方法。[方法]自1999年1月-2005年6月，60例患者因血流动力学不稳而行骨盆动脉造影。男42例，女18例；年龄21—52岁，平均34．5岁。对造影片上骨盆动脉吻合出现的类型及数量进行观测。[结果]从骨盆的动脉造影上观测到的动脉吻合支为：腰动脉与髂腰动脉100％；髂腰动脉与旋髂深动脉88．33％：闭孔动脉与腹壁下动脉吻合（或髂外动脉）36．67％；臀下动脉与阴部内动脉吻合26．67％；骶外侧动脉与骶中动脉及对侧骶外侧动脉吻合100％；臀下动脉与旋股内外动脉及股深动脉升支吻合56．67％；臀上动脉与臀下动脉吻合61．67％。[结论]骨盆骨折出血时，应实施超选择栓塞即栓塞出血动脉的断端及其吻合支，从而减少动脉栓塞引起的并发症。     

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 critical hypogastric circulation

Eleven patients had ischemic complications secondary to ligation, hypoperfusion, exclusion, or thrombosis of the hypogastric arteries after aortoiliac reconstruction or spontaneous aortoiliac thrombosis. Ligation of one hypogastric artery resulted in persistent ipsilateral buttock claudication in three patients. Bilateral acute hypogastric artery ischemia occurred in eight patients and resulted in paralysis in all eight patients, buttock necrosis in four patients, anal and bladder sphincteric dysfunction in two patients, and colorectal ischemia in three patients. Five of these patients (63 percent) died. The mortality rate was 100 percent when buttock necrosis developed. In most of these patients, the neurologic deficit suggested ischemic injury of the lumbosacral plexus rather than spinal cord ischemia. These complications occurred despite patent bypass grafts to the iliac or femoral vessels. These observations suggest that it is essential to maintain patency of the hypogastric vessels in all aortoiliac reconstructions.     

Amplatzer Vascular Plug to occlude the internal iliac arteries in patients undergoing aortoiliac aneurysm repair

PURPOSE: The purpose of this report is to evaluate the use of conventional coils and the Amplatzer Vascular Plug, a type of nitinol-based self-expanding device, to occlude the internal iliac artery in patients undergoing aortoiliac or common iliac aneurysm endograft repair, or both. METHODS: Between August and December 2004, in preparation for endograft repairs of aortoiliac or common iliac artery aneurysms, or both, at a community hospital system, five patients underwent the occlusion of the internal iliac artery with an Amplatzer Vascular Plug to prevent endoleak. During the preceding 12 months, the conventional coil embolization of the internal iliac artery was used for the same purpose in 10 patients. RESULTS: In five patients undergoing the Amplatzer Vascular Plug occlusion of the internal iliac artery, precise deployment at the origin of the artery was achieved. Complete and precise occlusion was confirmed angiographically, and only one device was used for each internal iliac artery. Two patients reported mild buttock claudication 2 weeks after occlusion, which resolved completely by 6 and 8 weeks, respectively. A type II endoleak from the inferior mesenteric artery developed in one patient. In the previous 10 patients, 11 internal iliac arteries were treated with conventional coils. Subsequent repeat coil embolization was required for three patients. The procedural complications in this second group included one case of coil embolization into the superficial femoral artery and one into the common iliac artery; both errant coils were retrieved successfully by endovascular techniques. An average of 7 +/- 3.4 (mode of 5) coils were used for each internal iliac artery. Three cases of buttock claudication occurred after the unilateral internal iliac artery occlusion in this group and did not resolve. No evidence of ischemic bowel, buttock necrosis, or sexual dysfunction was observed in either group. The estimated average cost to occlude one internal iliac artery was 375 dollars for Amplatzer Vascular Plugs and 3,500 dollars for conventional coils. CONCLUSIONS: The Amplatzer Vascular Plug allows for a cost-effective method to occlude the internal iliac artery in patients undergoing endograft repairs of aortoiliac aneurysms. The use of a single device with a precise placement at the origin of the artery minimizes cost and avoids ischemic complications.     

Distal internal iliac artery embolization: a procedure to avoid

OBJECTIVES: Internal iliac artery (IIA) coil embolization as an adjunct to endovascular stent grafting (ESG) is common practice for treating abdominal aortic aneurysm (AAA) in patients with a substantially enlarged common iliac artery requiring extension of the stent-graft limb into the external iliac artery. The literature describing pelvic ischemia in association with IIA coil embolization contains conflicting reports of symptom severity. We studied IIA occlusion outcome as a function of coil placement in the IIA. METHODS: From August 1997 to March 2002, 20 patients with AAA underwent ESG with unilateral IIA coil embolization. Coils were placed proximal to the first branch of the IIA in 8 patients and distal to the first branch in 12 patients. Symptoms of pelvic ischemia and mid-term outcome were studied. RESULTS: Patients included 18 men and 2 women with mean age of 70(1/2) years (range, 53-86 years). Mean diameter of AAA was 54.4 mm (range, 38-80 mm), and of common iliac artery was 24.2 mm (range, 15-48 mm). Ten patients (50%) had new onset of symptoms of pelvic ischemia after endograft procedures: 1 of 8 patients (13%) with proximal IIA embolization had buttock claudication, and 9 of 12 patients (75%) with distal IIA embolization had pelvic ischemic symptoms, including buttock claudication in 8 and impotence in 1 (P =.02, Fisher exact test). No colonic ischemia occurred in this series. At 12-month follow-up, 4 patients with distal IIA embolization were symptom-free. At further follow-up to 24 months, 4 patients remained significantly limited with symptoms of claudication. CONCLUSIONS: A significantly higher incidence of symptoms of pelvic ischemia occurred with more distal placement of coils for IIA embolization. Failure to control for extent of coil placement may account for the apparently conflicting results in published studies. IIA coil embolization should be performed as proximal as possible to prevent interference with pelvic collateral circulation.     

Hypogastric artery embolization in endovascular abdominal aortic aneurysm repair

PURPOSE: Iliac artery anatomy is a central factor in endoluminal abdominal aortic aneurysm therapy. It serves as the conduit for graft deployment and as the region of distal graft seal. Thirty-eight percent of iliac vessels in our patients require special treatment because of aneurysms, tortuosity, or small size. Bilateral hypogastric artery exclusion has been avoided because of concerns of colorectal ischemia, hip/buttock claudication, and impotence. We suggest that elective, staged, bilateral hypogastric embolization can be performed safely with reasonably low morbidity and can expand the anatomic boundaries for stent-graft abdominal aortic aneurysm repair. METHODS: This study was performed as a retrospective chart review of patients requiring hypogastric artery embolization for endovascular repair of abdominal aortic aneurysms between June 1998 and June 2000. Patients with otherwise appropriate anatomy and common iliac artery aneurysms were informed of the option for stent-graft repair with internal iliac artery embolization with its risks of impotence, hip/buttock claudication, and bowel ischemia. Patients underwent unilateral or staged bilateral coil embolizations of their proximal hypogastric arteries with an approximate 1-week interval between procedures. Hospital and office records were reviewed; phone interviews were performed. Follow-up ranged from 1 to 12 months. RESULTS: During a 24-month period, 65 patients underwent endovascular abdominal aortic aneurysm repair; 18 patients (28%) required hypogastric artery embolization. Seven (39%) of these patients underwent bilateral embolization. There were no episodes of clinically evident bowel ischemia. Lactate levels were normal in all measured patients. Postoperative fevers (> 101.0 degrees F) were documented in 10 (56%) of 18 patients. The average white blood cell count was 12.8 x 10(9)/L (range, 8.5-22.9). There were no positive blood culture results. The return to the full preoperative diet occurred in 1 to 3 days. Hip/buttock claudication occurred in approximately 50% of patients with persistent but improved symptoms at 6 months. Eighty-seven percent of patients had preoperative erectile dysfunction. Only two patients noted worsening of erectile function postoperatively. CONCLUSIONS: Preliminary results indicate that bilateral hypogastric artery embolization can be performed, when necessary, with reasonable morbidity in patients undergoing stent-graft abdominal aortic aneurysm repair.     

Internal iliac artery revascularization as an adjunct to endovascular repair of aortoiliac aneurysms.

PURPOSE: Endovascular repair of aortoiliac aneurysms may be limited by extension of the aneurysm to the iliac bifurcation, necessitating endpoint implantation in the external iliac artery. In such cases the circulation to the internal iliac artery is interrupted. Bilateral internal iliac artery occlusion during endovascular repair may be associated with significant morbidity, including gluteal claudication, erectile dysfunction, and ischemia of the sigmoid colon and perineum. We have employed internal iliac artery revascularization (IIR) to allow endograft implantation in the external iliac artery while preserving flow to the internal iliac artery in patients with aneurysms involving the iliac bifurcation bilaterally. METHODS: A total of 11 IIR procedures were performed in 10 patients undergoing endovascular abdominal aortic aneurysm (AAA) repair (9 men, 1 woman; mean age, 74 years). IIR was accomplished via a retroinguinal incision in 9 cases and a retroperitoneal incision in 2 cases. Six-mm polyester grafts were used for external-to-internal iliac artery bypass in 10 cases and internal iliac artery transposition onto the external iliac artery was used in one case. Endovascular AAA repair was performed using a modular bifurcated device (Talent-LPS, Medtronics, Minneapolis, Minn) after IIR. Bypass graft patency was determined immediately after the surgery, at 1 month, and every 3 months thereafter, using duplex ultrasound scanning and computed-tomography angiography. Mean aneurysm diameters were as follows: AAA, 6.4 +/- 0.7 cm; ipsilateral common iliac, 3.7 +/- 1.0 cm; contralateral common iliac, 3.9 +/- 0.8 cm. RESULTS: Successful IIR and endovascular AAA repair were accomplished in all cases. No proximal, distal, or graft junction endoleaks occurred. Two patients demonstrated retrograde aneurysm side-branch endoleaks originating from the lumbar arteries. One thrombosed spontaneously within 3 months. One perioperative myocardial infarction occurred. Reduction in aneurysm size was documented in 5 aortic, 5 ipsilateral iliac, and 3 contralateral iliac aneurysms. Gluteal claudication, erectile dysfunction, colon and perineal ischemia, and mortality did not occur. All IIRs have remained patent during a follow-up period of 4 to 15 months (mean, 10.1 months). CONCLUSIONS: IIR may be used with good short-term to intermediate-term patency to prevent pelvic ischemia in patients whose aneurysm anatomy requires extension of the endograft into the external iliac artery. This may allow endovascular AAA repair to be performed in patients who might otherwise be at risk for developing complications associated with bilateral internal iliac artery occlusion.     

Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair

PURPOSE: Hypogastric artery interruption is sometimes required during aortoiliac aneurysm repair. We have not experienced some of the life-threatening complications of pelvic ischemia reported by others. Therefore we analyzed our experience to identify factors that help minimize pelvic ischemia with unilateral and bilateral hypogastric artery interruption. METHODS: From 1995 to 2003, 48 patients with aortoiliac aneurysm required interruption of both hypogastric arteries as part of endovascular (n = 32) or open surgical (n = 16) repair. During endovascular aneurysm repair coils were placed at the origin of the hypogastric arteries, and bilateral hypogastric artery interruptions were staged at 1 to 2 weeks when possible. Open surgery necessitated oversewing or excluding the origins of the hypogastric arteries and extending the prosthetic graft to the external iliac or femoral artery. Collateral branches from the external iliac and femoral arteries were preserved, and patients received systemic heparinization (50 units/kg). RESULTS: There was no buttock necrosis, ischemic colitis requiring colon resection, or death with the bilateral hypogastric artery interruption. Initially buttock claudication developed in 20 patients (42%), but persisted in only 7 patients (15%) at 1 year. New onset of impotence occurred in 4 of 28 patients (14%), and there were no neurologic deficits. CONCLUSIONS: Bilateral hypogastric artery interruptions can be accomplished with limited morbidity. When hypogastric artery interruption is needed during endovascular aneurysm repair, certain principles help minimize pelvic ischemia. These include hypogastric artery interruption at its origin to preserve the pelvic collateral vessels, staging bilateral hypogastric artery interruptions when possible, preserving collateral branches from the femoral and external iliac arteries, and providing adequate heparinization of the patient during these procedures.     

Adverse consequences of internal iliac artery occlusion during endovascular repair of abdominal aortic aneurysms

OBJECTIVE: Embolization of the internal iliac artery (IIA) may be performed during endovascular abdominal aortic aneurysm (AAA) repair if aneurysmal disease of the common iliac artery precludes graft placement proximal to the IIA orifice. The IIA may also be unintentionally occluded because of iliac trauma or coverage by the endograft. The purpose of this study was to determine the incidence, etiology, and consequences of IIA occlusion during endoluminal AAA repair. METHODS: Over 2 years, 96 patients have undergone endoluminal AAA repair. The details of the operative procedure, reasons for IIA occlusion, perioperative complications, and clinical follow-up were recorded. RESULTS: The IIA was intentionally occluded in 15 patients (16%) to treat 13 common iliac artery aneurysms, one IIA aneurysm, and one external iliac artery aneurysm. The IIA was unintentionally occluded in 9 patients (9%), resulting from traumatic iliac dissection in 5 patients and coverage of the IIA by the endograft in the remaining 4 patients. Three patients had colon ischemia. One patient with a unilateral IIA occlusion had sigmoid infarction necessitating resection. The other two patients underwent intentional occlusion of one IIA followed by unintentional occlusion of the contralateral IIA because of a traumatic iliac dissection. Both had postoperative abdominal pain and distention; rectosigmoid ischemia was revealed through colonoscopy. Conservative treatment with bowel rest and broad-spectrum antibiotics was successful in both cases. Nondisabling hip and buttock claudication occurred in seven patients (32%) at 1 month but resolved by 6 months in three of these patients. CONCLUSION: Embolization of the IIA for iliac aneurysmal disease and unintentional IIA occlusion due to trauma or graft coverage occurs in a considerable number of patients undergoing endoluminal AAA repair. Most patients with unilateral occlusion do not experience colon ischemia or disabling claudication. Therefore, unilateral embolization of the IIA is well tolerated and allows for the endoluminal treatment of patients with both an AAA and an iliac artery aneurysm, thereby expanding the number of patients who can be managed with an endovascular approach. Although acute, bilateral IIA occlusions should be avoided, significant consequences were not observed in our small series of patients.     

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。