腹主动脉瘤腔内修复中髂动脉入路困难治疗策略

Management strategy of iliac artery difficulty in abdominal aortic aneurysm endovascular repair

目的探讨腹主动脉瘤腔内修复中髂动脉入路困难治疗的策略。方法回顾性分析2010年3月—2019年3月于新疆维吾尔自治区人民医院血管外科接受腔内手术治疗的275例合并髂动脉病变腹主动脉瘤患者的临床资料,记录患者的年龄、性别、合并症等一般临床资料,对于存在困难入路的患者实施相应的手术,分析困难入路情况类型的发生率、处理措施以及效果。结果275例患者均接受腔内修复术,其中78例(28.3%)存在髂动脉入路困难,其中髂动脉轻度狭窄29例(10.5%),重度狭窄7例(2.54%),闭塞3例(1.09%),扭曲39例(14.2%),对于血管扭曲者使用超硬导丝纠正髂动脉成角,对于髂动脉狭窄者进行球囊扩张、对于严重狭窄无法通过者通过侧腹膜行人工血管旁路移植后支架置入等处理后均成功实施腔内修复。结论入路血管病变会导致腹主动脉瘤腔内治疗困难,根据不同困难进行相应的处理后行腔内修复术,均可以获得成功,远期通畅率较好。

Objective To explore the strategies for the treatment of difficult iliac artery approach in endovascular repair of abdominal aortic aneurysm.Methods The clinical data of 275 patients with abdominal aortic aneurysm who underwent endovascular surgery at the Department of Vascular Surgery,People′s Hospital of Xinjiang Uygur Autonomous Region from March 2010 to March 2019 were retrospectively analyzed,and the general clinical data such as age,gender,and comorbidities of the patients were recorded.The resource index was to carry out corresponding measures to perform surgery for patients with difficult access,analyze the incidence of the type of difficult access,treatment measures and effects.Results Two hundred and seventy-five patients underwent endovascular repair,78 of them(28.3%)had difficulty in accessing the iliac artery,including 29 cases(10.5%)with mild iliac artery stenosis,7 cases(2.54%)with severe stenosis,and 3 cases with occlusion(1.09%),39 cases(14.2%)were twisted.For patients with vascular twist,super-hard guide wire was used to correct iliac artery angulation.For patients with iliac artery stenosis,balloon dilation was performed.For severe stenosis,the artificial blood vessel was passed through the lateral peritoneum.After road transplantation,stent placement and other treatments were successfully performed endovascular repair.Conclusions Pathway vascular disease can cause difficulties in endovascular treatment of abdominal aortic aneurysms.Endovascular repair can be successfully performed after corresponding treatments according to different difficulties,and the long-term patency rate is good.