腔内修复术治疗孤立性髂动脉瘤7例分析

Endovascular stent-grafts in the treatment of isolated iliac artery aneurysms:an analysis of 7 cases

目的总结腔内修复术治疗孤立性髂动脉瘤的经验。方法回顾性分析2004年10月至2006年3月复旦大学附属中山医院血管外科收治的腔内修复孤立性髂动脉瘤7例的临床资料。其中,右髂总动脉瘤4例,左髂总动脉瘤2例,左髂内动脉瘤破裂1例。结果7例均取得技术成功。3例右髂总动脉瘤累及右髂内动脉,选用分叉支架型人工血管行腔内修复术。1例右髂总动脉瘤累及腹主动脉下端,选用AUI(Aortouniiliac)支架型人工血管腔内修复加股动脉旁路术。2例左髂总动脉瘤选用直型支架型人工血管。1例左髂内动脉瘤破裂急诊行钢圈栓塞后选用直型支架覆盖左髂内动脉开口。术后即刻数字减影血管造影(DSA)造影显示动脉瘤消失,远近端支架型人工血管与宿主动脉结合处均未见明显渗漏。1例术后出现急性左心功能不全和肺水肿,经抢救痊愈,其余6例无手术并发症。术后随访1～19个月(平均10.6±6.42个月),瘤体无增大,支架无移位,无内漏,旁路人工血管通畅。结论腔内修复术治疗孤立性髂动脉瘤具有可行、安全、微创等特点,近期疗效较好,远期效果尚须进一步随访。

Objective To summarize the therapeutic effects of endovascular repair for isolated iliac artery aneurysms （IAA）. Methods Seven patients were treated with transluminally placed endovascular stent-grafts from October 2004 to March 2006 and the results were analyzed. Among them, four cases were right common IAA and two cases were left common IAA. One case was left internal IAA with rupture. Results Technical success was achieved in all cases. Three cases with right common IAA involved right internal iliac artery were treated with bifurcated aorta-iliac stem-grafts. One case with right common IAA involved the bottom of abdominal aorta was treated with AUI stem-graft and femorofemoral bypass. Two cases with left common IAA were treated with tubular stent-grafts. One case with left internal IAA rupture was treated emergently with tubular stem-graft after ipsilateral internal iliac artery embolization with coils. DSA carded out immediately after the procedure showed the IAA were completely excluded by stem-grafts and no serious endoleaks both on the proximal or distal connections. One case with acute left ventricular dysfunction and alveolar edema postoperatively was recovered after emergent treatment and there were no complications in another six cases. All patients were followed up for 1 to 19 months （ a mean of 10. 6 ± 6. 42 months）, no aneurysms enlargement, no stent-grafts migration, no endoleak, femorofemoral bypass was patent. Conclusion Endovaseular repair of IAA is a minimally invasive, safe and feasible technique and provides good short-term patency, but the long-term patency need follow up.