术中自制髂动脉分支支架治疗主髂动脉瘤的单中心经验

Physician modified iliac branch devices for the endovascular treatment of aorta-iliac aneurysms:single center experience

目的:总结术中自制髂动脉分支支架(IBD)在主髂动脉瘤腔内修复术中保留髂内动脉的经验。方法:回顾性分析2018年1月至2018年12月在南京大学医学院附属鼓楼医院13例主髂动脉腔内修复术中使用自制髂动脉分支支架重建髂内动脉患者资料,其中2例重建双侧髂内动脉,11例单侧髂内动脉,术后观察盆腔缺血症状发生、髂内分支支架通畅率、有无内漏及瘤体扩张等情况。结果:应用自制IBD保留髂内动脉技术成功率为100%,术中出现2例Ⅲ型内漏,1例Ⅱ型内漏,围术期无其他并发症发生。术后平均随访9(4~12)个月,无瘤体扩张,支架内未见明显血栓形成,无瘤体相关性死亡,2例Ⅲ型内漏消失,1例Ⅱ型内漏持续存在,但瘤体无增大;IBD支架和髂内动脉通畅率为100%。1例对侧髂内栓塞患者术后出现对侧臀肌跛行,随访3个月后症状消失,无勃起、大小便功能障碍等症状出现。结论:术中自制IBD的应用是一种安全、有效的选择,近期效果理想,远期管腔通畅率还有待进一步随访。

Objective To summarize experience and short-term efficacy of preservation of internal iliac artery in endovascular aorta-iliac artery repair with physician modified iliac branch devices(IBD).Methods Thirteen patients’internal iliac arteries were reconstructed by endovascular aorta-iliac artery repair with physician modified iliac branch devices,including two bilateral contractions and eleven unilateral contractions.Regular follow-up were reviewed as well.Results Success rate of the surgeries was 100%.Two typeⅢendoleaks and one typeⅡendoleak occurred without the other complications.The average follow-up time was 9 months(4-12 months)and no sack enlargement,stent thrombus and death occurred.Two typeⅢendoleaks disappeared,while one typeⅡendoleak still exist without enlargement of aneurysm during the follow-up.IBD and internal iliac artery were well patency(100%).One case of buttock claudication got better after 3 months,no erectile and defecation dysfunction occurred.Conclusion The physician modified iliac branch devices are safe and effective.The short-term efficacy is favorable and long-term lumen patency rate remains to be further followed up.