腹主动脉瘤腔内修复术后髂支闭塞的原因和处理:单中心10年经验

Causes and treatment strategies for iliac limb occlusion after endovascular aortic repair of abdominal aortic aneurysm:A single-center experience for 10 years

目的探讨腹主动脉瘤腔内修复术后发生髂支闭塞的原因及治疗策略。方法回顾性分析2013~2022年中山大学附属第一医院血管外科收治的819例腹主动脉瘤腔内修复术患者的临床资料,共18例(2.20%)患者术后并发髂支闭塞,其中15例采用手术治疗,3例行保守治疗。结果手术治疗技术成功率为100%,患者临床症状均缓解或消失。围术期无动脉破裂出血、心肌梗死、脑梗死、肾功能衰竭及死亡等严重不良事件发生。患者术后随访1~89个月,中位时间24.4个月,2例患者分别因心肌梗死及A型夹层在术后1个月及8个月死亡。3例患者再发髂支闭塞,无截肢等不良事件发生。结论髂支闭塞是腹主动脉瘤腔内修复术后常见并发症,应仔细分析原因并选择合适的治疗方案,开放手术、腔内治疗还是复合手术都是有效的治疗方法。

Objective To explore the causes and treatment strategies for iliac limb occlusion after endovascular aortic repair of abdominal aortic aneurysm.Methods The clinical data of 819 patients with iliac limb occlusion after endovascular aortic repair of abdominal aortic aneurysm admitted to the Department of Vascular Surgery,the First Affiliated Hospital of Sun Yat-sen University between 2013 and 2022 were analyzed retrospectively.A total of 18 cases(2.20%)were complicated with iliac limb occlusion,of which 15 cases were treated surgically and 3 cases were treated conservatively.Results The success rate of surgical treatment was 100%,and patients experienced relief or disappearance of clinical symptoms.There were no serious adverse events such as arterial rupture and bleeding,myocardial infarction,cerebral infarction,renal failure and death during the perioperative period.Patients were followed up for 1-89 months after surgery,with a median time of 24.4 months.Two patients died at 1 month and 8 months post-surgery due to myocardial infarction and type A dissection,respectively.Three cases experienced recurrent iliac limb occlusion after surgery,but no adverse events such as amputation occurred.Conclusion Iliac branch occlusion is a common complication after endovascular aortic repair of abdominal aortic aneurysm.The causes should be carefully analyzed and an appropriate treatment plan should be selected.Open surgery,endovascular treatment and hybrid surgery are all effective treatment methods.