腔内技术重建髂内动脉治疗单纯髂动脉病变的近期疗效观察

背景与目的：髂内动脉病变可引起多种临床症状,积极治疗能明显改善患者的预后和生活质量。开放手术是髂动脉病变治疗的经典方法,但在技术方面要求更高,给患者带来的风险也更大,腔内技术重建髂内动脉已得到广泛应用,目前这方面的进展主要集中在合并腹主动脉瘤等治疗上,单纯针对髂动脉病变的研究较少。而且由于病变种类、解剖结构的复杂性,国内外尚无专门的指南或专家共识指导髂内动脉病变的诊治,腔内治疗技术缺少统一的规范。这就要求临床诊疗过程中术者需根据病变特点、入路解剖、自身经验等制定因人而异的策略。目前应用较为广泛、技术相对成熟的腔内治疗方法有腔内血管成形术、支架植入术等,合并髂外动脉者有“三明治”技术、分支支架技术等,各有利弊。本研究观察采用前述常见的腔内修复方法,针对髂内动脉病变患者,根据不同病情选择不同重建方案的近期治疗效果,以探讨应用个体化腔内技术重建髂内动脉的可行性。方法：回顾性分析2015年11月—2022年6月在国家心血管病中心行髂内动脉重建的13例单纯髂动脉病变患者资料。主要结局指标为有无术后新发臀肌跛行、勃起功能障碍等髂内动脉缺血症状,次要结局指标包括术后至少1个月复查主动脉CTA显示血流...

Short-term outcomes of endovascular reconstruction of internal iliac artery in the treatment of isolated iliac artery disease

Background and Aims Internal iliac artery lesions can cause various clinical symptoms, and aggressive treatment can significantly improve patients'' prognosis and quality of life. Open surgery is the classic method for treating iliac artery lesions, but it requires higher technical demands and carries greater risks for patients. Endovascular techniques for reconstructing the internal iliac artery have been widely applied, with current progress mainly focusing on the treatment of concomitant abdominal aortic aneurysms, and there is limited research specifically targeting the internal iliac artery lesions. Furthermore, due to the complexity of lesion types and anatomical structures, there are no specialized guidelines or expert consensus at home and abroad to guide the diagnosis and treatment of internal iliac artery lesions, and there is a lack of standardized protocols for endovascular treatment techniques. This requires clinicians to develop individualized strategies based on the characteristics of the lesions, anatomical considerations, and personal experience. Currently, the more widely used and technically mature endovascular treatment methods include endovascular angioplasty and stent placement, while for those with concomitant external iliac artery lesions, "sandwich"technique and branch stenting have their advantages and disadvantages. This study was performed to observe the short-term treatment outcomes of employing the aforementioned commonly used endovascular repair methods and selecting different reconstruction strategies based on the individual conditions of patients with internal iliac artery lesions, to explore the feasibility of using personalized endovascular techniques for reconstructing the internal iliac artery.Methods The data of 13 patients with isolated iliac artery lesions who underwent internal iliac artery reconstruction at the National Cardiovascular Center from November 2015 to June 2022 were retrospectively analyzed. The primary endpoints were the incidence of postoperative symptoms of internal iliac artery ischemia such as buttock claudication and erectile dysfunction. The secondary outcome variables included such as the patency of blood flow and the presence of endoleaks, stent displacement, restenosis on aortic CTA at least 1 month after the procedure.Results Among the 13 patients, there were 12 males and 1 female, with a mean age of 62 (46-73) years. Based on preoperative imaging findings and the characteristics of the lesions, appropriate surgical methods were selected. Among them, 8 cases with internal iliac artery stenosis at the ostium were treated with simple balloon angioplasty, 4 cases with iliac artery aneurysm, dissection, or penetrating ulcers were treated with covered stent endovascular exclusion, and 1 case with common iliac artery aneurysm and iliac artery involvement was treated with the "sandwich"technique. All patients successfully underwent unilateral iliac artery revascularization without perioperative complications such as myocardial infarction, major bleeding, limb embolism, or death. The median follow-up time was 3.9 (1-22) months. During the follow-up period, none of the patients experienced ischemic symptoms in the iliac artery supply region. The CTA results showed that the blood flow in the ipsilateral iliac artery and external iliac artery was unobstructed, and the stent morphology and position were normal, with no evidence of endoleaks, embolism, or aneurysm expansion. Two cases with severe stenosis at the internal iliac artery ostium treated with simple balloon angioplasty showed moderate residual stenosis on follow-up at 3 months after operation, but both were relieved compared to the preoperative condition.Conclusion The application of endovascular techniques for treating internal iliac artery lesions is safe and feasible. The specific surgical approach should be selected based on individualized conditions.