孤立性髂动脉瘤的腔内治疗

Endovascular management for isolated iliac artery aneurysm

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。

Objective To evaluate endovaseular management for isolated iliae artery aneurysm （IIAA）. Methods From May 1997 to Jan 2006, 15 IIAA eases underwent endovaseular treatment, including 12 true aneurysms and 3 psudoaneurysms. There were 9 eommon iliac artery aneurysms （ CIAA）, 3 internal iliae artery aneurysms （IIAA）, and 3 extemal iliac artery aneurysms （EIAA）. The average diameter was （5. 97 ± 1.49） cm （3. 5 ±9. 0 cm）. ⅡAA was treated with metallie eoils and CIAA/EIAA by stent-grafts. Results Unilateral intemal iliae artery was preserved in 14 eases, and bilateral intemal arteries were preserved in one ease. Postoperative endoleak was found in 2 eases. There was no other major eomplieations nor mortality. One ease suffered buttock elaudieation beeause of intemal iliae artery exclusion. The operation time was 1.9 ± 1.1 h, blood loss was 126. 7 ±70. 1 ml. Patients were up and about after 2. 1 ±1.1 d, hospital stay was 5.5 ±4. 7 d. Conclusions Endovaseular treatment is safe and effeetive for isolated iliac artery aneurysm. Internal iliac artery preservation and prevention of endoleak is of great importanee.