孤立性髂动脉瘤介入治疗39例临床分析

Interventional treatment for isolated iliac artery aneurysm:A clinical data of 39 cases

目的探讨孤立性髂动脉瘤介入治疗的临床经验。方法回顾性分析2010年1月至2018年9月昆明医科大学附属延安医院血管介入科采用覆膜支架介入治疗孤立性髂动脉瘤39例,术后3个月、6个月及之后的每年对病人进行随访,探讨相关治疗方法。结果 39例病人分型有1A:Ⅰ型1例,1B:Ⅱ型8例,1D:Ⅳ型17例,2B:Ⅱ型2例,2D:Ⅳ型1例,2E:V型10例。平均瘤体最大直径为(42.4±11.2)mm(23.0~77.0 mm)。39例病人均顺利完成介入手术治疗,技术成功率100%,术中保留双侧髂内动脉1例,保留一侧髂内动脉29例,双侧髂内动脉均封闭9例,术中行一侧髂内动脉栓塞9例,行双侧髂内动脉均栓塞1例,手术时间为(49.0±17.0)min(35.0~87.0 min),术后随访(31.9±17.7)个月(5~69个月),术后除1例左髂动脉瘤破裂且合并肾衰竭的病人死亡,其余病人均好转出院,复查CTA示髂动脉瘤被完全封闭,支架形态位置良好,无内漏及其他并发症。结论孤立性髂动脉瘤起病隐匿,早期多无症状,CT等检查能够早期诊断。介入治疗是安全有效的方法。应注意在术前根据髂动脉瘤的累及范围,近远端有无足够的锚定区进行分型,并对不同分型进行有差别的个体化治疗。

Objective To explore the clinical experience of interventional therapy for isolated iliac artery aneurysm(IIAA).Methods A total of 39 cases of isolated iliac aneurysms were treated with covered stent in Department of Vascular Intervention,Yan’an Hospital Affiliated to Kunming Medical University from January 2010 to September 2018.The patients were followed up for 3 months,6 months and every year after the operation to explore the relevant treatment methods.Results Thirty-neen patients were divided into 1 case of type 1 A:Ⅰ,8 cases of 1 B:Ⅱ,17 cases of 1 D:Ⅳ,2 cases of 2 B:Ⅱ,and 1 case of 2 D:Ⅳ,10 cases of 2 E:Ⅴ.The maximum diameter of the tumor was 42.4±11.2 mm(23.0-77.0 mm).All 39 patients successfully completed the interventional treatment,the technical success rate was 100%.During the operation,1 case had bilateral internal iliac artery reserved,29 cases had one internal iliac artery reserved,9 cases had bilateral internal iliac artery blocked,9 cases had one internal iliac artery embolized during the operation,1 case had both internal iliac arteries embolized,the average operation time was 49.0±17.0 min(35.0-87.0 min),and the average follow-up was 31.9±17.7 months(5.0-69.0 months).After operation,except for one case of left iliac aneurysm rupture and renal failure,the rest of the patients improved and discharged.CTA showed that the iliac aneurysm was completely closed,the stent shape and position were good,and there was no internal leakage and other complications.Conclusion Solitary iliac artery aneurysm is occult and asymptomatic in the early stage.CT can be used for early diagnosis.Interventional therapy is a safe and effective way to treat ⅡAA.Attention should be paid to whether there is enough anchorage area near and far end according to the involved range of ⅡAA before operation,to classify the lesions,and to carry out individualized treatment for different types of ⅡAA.