腔内修复在孤立性髂动脉瘤患者中的疗效观察

Endovascular repair for isolated iliac artery aneurysm

目的探讨孤立性髂动脉瘤腔内治疗的近、中期疗效。方法回顾性分析2008年1月至2012年12月于复旦大学附属中山医院血管外科行腔内修复术的孤立性髂动脉瘤27例的临床及随访资料。腔内修复治疗的指征是无症状患者动脉瘤直径〉3cm，有症状者动脉瘤直径可〈3em。结果无症状患者19例，有症状患者8例；择期手术25例，急诊手术2例。单纯人工血管内支架修复术17例，单纯栓塞修复术1例，人工血管内支架合并栓塞修复7例，杂交手术2例，技术成功率为100％。腔内术后无腹股沟伤口感染或延迟愈合者，支架内血栓形成者2例，臀部间跛1例，性功能减退3例，术中DSA造影存在内漏者3例，无结直肠缺血及动脉瘤破裂病例。术后平均随访（33±18）个月，死亡1例，死亡原因为肾癌复发。结论腔内修复术治疗孤立性髂动脉瘤的近、中期疗效较好，选择合适的腔内修复方案可能成为未来治疗孤立性髂动脉瘤的首选。

Objective To evaluate the short and middle-term efficacies of endovascular repair for isolated iliac artery aneurysms （IIAAs）. Methods Retrospective analyses were performed for the clinical and follow-up data of 27 patients undergoing endovascular repair at Department of Vascular Surgery, Affiliated Zhongshan Hospital, Fudan University from January 2008 to December 2012. For asymptomatic aneurysms, repair criterion was a diameter over 3 cm while under 3 em for symptomatic aneurysms. Results There were 19 asymptomatic and 8 symptomatic cases. And 25 selective and 2 emergent operations were performed. The interventions included endovascular stent grafts （n = 17）, coil embolization （n = 1 ）, both stent grafts and coils （ n = 7） and hybrid operations （ n = 2）. Technical success was achieved in all cases. No delayed healing or infection of inguinal access sites occurred. In-stent thrombosis could be observed in 2 cases. Buttock claudication was observed in one case. Sexual dysfunction occurred in three cases. Endoleaks were confirmed by intraoperative digital subtraction angiography in three cases. There was no occurrence of colorectal ischemia or postoperative aneurysmal rupture. Patients were followed up for a mean period of 33 ＋ 18 months. One patient died of recurrent renal cell carcinoma. Conclusion Endovascular repair of isolated iliac artery aneurysms provides good short and middle-term patency. It may become a first-choice for treating isolated iliac artery aneurysms in the future.