合并双髂总动脉瘤的腹主动脉瘤的腔内治疗

Endovascular Treatment for Abdominal Aortic Aneurysm Combined with Bilateral Common Iliac Artery Aneurysm

目的总结腹主动脉瘤合并双髂总动脉瘤的腔内治疗经验。方法2009年1月～2012年3月，126例腹主动脉瘤接受腔内修复术（endovascularaneurysmrepair，EVAR），其中33例合并双髂总动脉瘤（直径〉18mm）。27例双侧髂总动脉直径〉18-〈25mm，选择合适口径的髂腿移植物完成传统EVAR；6例因-侧髂总动脉直径≥25mm，选择该侧髂外动脉作为锚定区完成EVAR，并行髂内动脉栓塞术。结果所有腔内技术均获得成功，手术时间（115±36）min，出血量（173±65）m1。术中发现即刻内漏7例（21．2％）：I型内漏3例（近端1例，远端2例，均经球囊扩张后内漏消失）；11I型内漏1例，经扩张后内漏消失；II型内漏2例，Ⅳ型内漏1例，经随访瘤体直径未增大，未予处理。33例术后随访6～39个月，平均15．3月，无动脉瘤破裂，无远端迟发型I型内漏发生，髂动脉直径无明显扩张。结论对于部分合并双髂动脉瘤的腹主动脉瘤患者，根据髂总动脉直径选择合适的腔内治疗方法可以达到理想的治疗效果，近期效果满意。

Objective To summarize experiences of endovascular treatment for abdominal aortic aneurysm combined with bilateral common iliac artery aneurysm. Methods From January 2009 to March 2012, endovaseular aneurysm repair （EVAR） was performed on 126 patients, including 33 patients complicated with bilateral common iliac artery aneurysm （ 〉 18 mm in diameter）. Among them, 27 patients with common iliac artery of more than 18 mm but less than 25 mm in diameter were treated with traditional EVAR with proper iliac stent graft ;6 patients with unilateral common iliac artery of 25 turn or more than 25 mm in diameter were treated with EVAR extending into the external iliac artery and embolism of ipsilateral internal iliac artery. Results All procedures were successfully completed. The operation time was （115 ＋ 36） min and blood loss was （173 ~ 65） ml. Intraoperative endoleak was found in 7 cases （21.2%） , including 3 cases of type I endoleak（proximal 1, distal 2） , 1 case of type Ill endoleak which was healed after dilatation, 2 cases of type ]I endoleak and 1 case of type 1V endoleak, which demonstrated no increase in sac diameter during the follow-up period and didn＇t receive further intervention. Mean follow-up of the 33 cases was 15.3 months （rang, 6 -39 months）, during which no aneurysm rupture occurred,and no delayed distal type I endoleak or dilation of the common iliac artery aneurysm was observed. Conclusions Abdominal aortic aneurysm with bilateral common iliac artery aneurysm can be successfully treated by using suitable endovascular techniques according to the diameter of common iliac artery. The short-term results are satisfactory.