Bell-bottom aortoiliac endografts: An alternative that preserves pelvic blood flow
Bell-bottom aortoiliac endografts: An alternative that preserves pelvic blood flow
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DOI：
10.1067/mva.2002.123326
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发表时间：
2002-05-01
影响因子：
4.3
通讯作者：
Beebe, HG
中科院分区：
文献类型：
--
作者：
Kritpracha, B;Pigott, JP;Beebe, HG
目的：使主动脉瘤支架植入术复杂化的髂总动脉扩张通常通过覆膜支架延伸穿过髂动脉分叉并髂内动脉（IIA）闭塞进行治疗。我们研究了25例显著髂总动脉（CIA）扩张治疗的两种方法：覆膜支架延长髂分叉或一个新的方法与扩口袖口内CIA，保留IIA.Methods：86例腹主动脉瘤（AAA）进行分叉血管内支架移植术（ESG），25（29.1%）至少有一个扩张的CIA。两个治疗组有不同的髂动脉扩张管理方法。第1组在ESG手术前（n=2）或与ESG同时（n=8）进行ESG，通过髂动脉分叉直伸和IIA弹簧圈栓塞。第2组使用CIA内的扩口远端袖套（AneuRx，Medtronic AVE，圣罗莎，加利福尼亚州）进行ESG，即所谓的“钟底”手术，从而保留IIA（n=15）。髂动脉尺寸，手术室时间，透视时间，术后并发症prospectively gathered.Results：两名女性和23名男性的平均直径的AAA为56.6毫米（范围，38至98毫米）和CIA的21.4毫米（范围，15至48毫米）。在IIA弹簧圈栓塞后，第1组和第2组中使用器械延伸至髂外动脉治疗的CIA直径无差异（平均CIA直径分别为19.9 mm;范围为15 - 26 mm;平均值为19.1 mm;范围为15 - 24 mm）。然而，与第1组相比，第2组的手术室和导管手术时间显著缩短（分别为137和192分钟; 58和106分钟; P= 0.02和0.02）。两组均未发现围手术期I型内漏。第2组中的9名患者还患有第二个对侧CIA动脉瘤，5名患者（平均CIA直径，33.0 mm;范围，22 - 48 mm）接受了髂动脉分叉和IIA闭塞的延长治疗。在另一侧使用钟形底程序可以保留一个IIA。4例（平均直径19.3 mm）还接受了对侧钟底手术。其中两组2例患者出现并发症，在一个和远端栓塞，需要保肢旁路术前线圈栓塞后的IIA在another.Conclusion：显着的CIA扩张或小动脉瘤往往与AAA。在这种情况下，保留IIA循环的钟底手术是在至少一个CIA直径小于26 mm的患者中跨髂动脉分叉放置覆膜支架延长件的常见做法的新替代方法。其他受益包括缩短总手术时间。早期的技术成功似乎证明了继续使用的合理性。然而，由于由于被排除髂动脉的潜在扩张或晚期失效导致的破裂风险尚不清楚，因此需要进行长期评价以确定耐久性。
Objective: Dilated common iliac arteries that complicate aortic aneurysm stent grafting usually have been managed with endograft extension across the iliac artery bifurcation with internal iliac artery (IIA) occlusion. We studied 25 patients with significant common iliac artery (CIA) dilation treated with two methods: endograft extension across the iliac bifurcation or a new approach with a flared cuff within the CIA that preserves the IIA.Methods: Of 86 patients with abdominal aortic aneurysm (AAA) who underwent bifurcated endovascular stent grafting (ESG), 25 (29.1%) had at least one dilated CIA. Two treatment groups had different methods of management of iliac artery dilation. Group 1 underwent ESG with straight extension across the iliac bifurcation and IIA coil embolization before the ESG procedure (n=2) or simultaneously with ESG (n=8). Group 2 underwent ESG with flared distal cuff (AneuRx, Medtronic AVE, Santa Rosa, Calif) contained within the CIA, the so-called "bell-bottom" procedure, thus preserving the IIA (n=15). Iliac artery dimensions, operating room time, fluoroscopy time, and postoperative complications were prospectively gathered.Results: Two women and 23 men had mean diameters of AAA of 56.6 mm (range, 38 to 98 mm) and of CIA of 21.4 mm (range, 15 to 48 mm). The diameters of CIA treated with device extension into external iliac artery after IIA coil embolization in group 1 and with the bell-bottom procedure in group 2 were not different (mean CIA diameter, 19.9 mm; range, 15 to 26 mm; and mean, 19.1 mm; range, 15 to 24 mm; respectively). However, significantly lower operating room and catheter procedure times were found in group 2 compared with group 1 (137 versus 192 minutes; 58 versus 106 minutes; P=.02 and .02, respectively). No periprocedural type I endoleaks were found in either group. Nine patients in group 2 also had a second contralateral CIA aneurysm, and five patients (mean CIA diameter, 33.0 mm; range, 22 to 48 mm) underwent treatment with extension across the iliac artery bifurcation and IIA occlusion. Use of the bell-bottom procedure on the other side allowed preservation of one IIA. Four cases (mean diameter, 19.3 mm) also underwent contralateral bell-bottom procedure. Two of these group 2 patients had complications, with severe buttock claudication in one and distal embolism necessitating limb salvage bypass after preoperative coil embolization of the IIA in another.Conclusion: Significant CIA ectasia or small aneurysm is often associated with AAA. In such cases, the bell-bottom procedure that preserves IIA circulation is a new alternative to the common practice of placement of endograft extensions across the iliac artery bifurcation in patients with at least one CIA diameter of less than 26 mm. Additional benefits include reduced total procedure time. Early technical success appears to justify continued use. However, long-term evaluation is necessary to determine durability because the risk of rupture as the result of potential expansion of the excluded iliac artery or late failure is unknown.