腔内治疗过程中髂动脉破裂的预防及处理

The treatment and preventive measures against iliac artery rupture during the process of endovascular therapy

目的 探讨腔内治疗中髂动脉破裂的处理及预防措施.方法 2004年6月至2013年7月,在施行腔内治疗过程中共发生髂动脉破裂病例12例;其中球囊扩张引起的5例,由导管导丝穿破引起的4例,支架移植物输送鞘损伤1例,支架末端刺破血管（迟发）1例,双腔取栓管回拉损伤1例.发生于髂总动脉4例,发生于髂外动脉者8例.结果 4例导管导丝相关性血管破裂均治愈;5例球囊扩张后血管破裂,经行球囊封堵及覆膜支架置入后均治愈,1例支架移植物输送鞘损伤者术中行开放性血管修复成功,但在术后第1天因DIC死亡;1例迟发性支架刺破血管者经置入覆膜支架后治愈;1例双腔取栓管患者,行裸支架置入术后第2天因消化道大出血死亡.6例覆膜支架置入患者平均随访（56±12）个月,结果显示支架均通畅,未见支架内再狭窄及局部假性动脉瘤形成.结论 术前充分评估髂股血管及闭塞原因,选择合适尺寸的球囊及柔韧性较好的金属支架可预防术中发生髂动脉破裂;覆膜支架置入是髂动脉破裂有效的处理措施.

Objective To evaluate the treatment and preventive measures for iliac artery rupture during the process of endovascular therapy.Methods From June 2004 to July 2013,there were 12 cases suffering from iliac artery rupture during endovascular treatment.Of those,rupture was caused by balloon dilation in 5 cases,caused by catheter or guide wire perforation in 4 cases and after stent graft convery sheath insertion in 1 case,rupture took place because of perforation from metal stent end in one,and by withdrawing of dual-cavity thrombectomy catheter in one.Rupture involved common iliac arteries in 4 and external iliac arteries in 8.Results The 4 cases in which rupture was caused by catheter and guide wire perforation were cured,and all 5 cases in whom rupture caused by balloon dilation were cured by balloon tamponading and coverd stent.Rupture caused by stent graft inserting was successfully repaired by open operation in 1 case,but subsequently died from DIC one day after.A tardive rupture after metal stent end perforation was treated with coverd stent successfully in one case.Another case in which dual-cavity thrombectomy catheter was the cause of rupture was treated with bare metal stent,and died of massive hemorrhage of gastrointestinal tract 2 days later.6 cases treated by coverd stent were followed up for （56 ± 12） months with stents patency in all cases,and there were no in-stent restenosis nor pseudoaneurysm.Conclusions In preventing iliac artery rupture,the sufficient evaluation of femoral and iliac artery before operation is necessary,and therefore proper size balloon and soft metal stent should be used.The placement of coverd stent is effective emergency treatment.