腹主动脉瘤腔内修复术后髂支闭塞的原因及治疗策略

Causes and treatment strategies for iliac limb occlusion after endovascular repair of abdominal aortic aneurysm

目的:探讨腹主动脉瘤(AAA)腔内修复术(EVAR)后髂支闭塞的原因及治疗策略。方法:回顾性收集2016年1月—2018年7月中南大学湘雅医院血管外科收治130例行EVAR的AAA患者临床资料,对其中并发髂支闭塞患者的临床资料进行分析。结果:130例成功接受EVAR的AAA患者中,6例(4.61%)发生术后髂支闭塞,均为单侧闭塞,发生闭塞的平均时间为(55±87)d。临床表现主要为间歇性跛行和静息痛。治疗方式包括:股动脉切开取栓+股-股动脉转流术2例,髂动脉支架植入术1例,股动脉切开取栓+髂动脉支架植入术3例。术后患肢缺血症状均消失。术后随访时间12个月,所有患者均未再次出现下肢缺血症状。结论:髂支闭塞是EVAR术后较为常见的并发症之一,其原因包括瘤颈条件差、髂动脉入路扭曲、髂支远端锚定区解剖异常等;股动脉切开取栓和(或)髂动脉支架植入是行之有效的治疗方法。

Objective:To investigate the causes and treatment strategies for iliac limb occlusion following endovascular aneurysm repair(EVAR)of abdominal aortic aneurysm(AAA).Methods:The clinical data of 130 AAA patients admitted in the Department of Vascular Surgery of Xiangya Hospital,Central South University during January 2016 to July 2018 were retrospectively collected,and the clinical data of those that developed postoperative iliac limb occlusion were analyzed.Results:Of the 130 AAA patients who successfully underwent EVAR,6 cases(4.61%)developed postoperative iliac limb occlusion,all of which were unilateral,and the average time to occurrence of occlusion was(55±87)d.The clinical manifestations of the patients mainly were intermittent claudication and rest pain.The treatment methods included embolectomy through a femoral arteriotomy plus femorofemoral bypass in 2 cases,iliac arterial stent placement in one case,and embolectomy through a femoral arteriotomy plus iliac arterial stent placement in 3 cases.The ischemic symptoms of the involved limb disappeared in all patients after operation.Postoperative follow-up was conducted for 12 months and no ischemic symptoms reappeared in any of them.Conclusion:Iliac limb occlusion is one of the relatively common complications following EVAR,and the reasons include unfavorable features of the aneurysmal neck,iliac stent-graft distortion,and anatomical abnormalities of the distal landing zone of the iliac limb are risk factors for graft limb occlusion.Embolectomy by femoral arteriotomy and/or iliac arterial stent placement are effective treatment approaches.