Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair.
Internal iliac occlusion without coil embolization during endovascular abdominal aortic aneurysm repair.
复制标题
腹主动脉瘤腔内修复术中不采用弹簧圈栓塞的髂内闭塞。
DOI：
10.1067/mva.2002.129639
复制
发表时间：
2002
影响因子：
4.3
通讯作者：
J. Cronenwett
中科院分区：
文献类型：
--
作者：
M. Wyers;M. Schermerhorn;M. Fillinger;R. Powell;Eva M. Rzucidlo;D. Walsh;R. Zwolak;J. Cronenwett
目的
当腹主动脉瘤和髂总动脉（CIA）动脉瘤同时接受腔内修复术时，通常需要将覆膜支架分支延伸至髂外动脉。通常，在这种情况下，髂内动脉（IIA）被弹簧圈栓塞以防止内漏。我们的实践是，仅在紧邻IIA起源近端的CIA中没有充分覆膜支架密封（有效密封整个IIA起源）的情况下，才对IIA进行弹簧圈栓塞。在这项研究中，我们评估了这种方法的结果。
方法
我们回顾性分析了1996年至2001年在达特茅斯-希区柯克医疗中心进行的204例连续腹主动脉瘤腔内修复术。计算机断层扫描血管造影和三维重建是术前的主要成像方式，术前根据CIA最远端5 mm和髂外动脉近端15 mm分别存在足够的移植物尺寸过大（>或= 10%至15%），决定覆盖IIA而不伴随弹簧圈栓塞。
结果
31例患者的IIA闭塞33次。在22例（67%）病例中，IIA被覆盖而未进行弹簧圈栓塞（COVER组）。其余11名CIA中移植物尺寸过大不充分的患者（33%）接受了IIA弹簧圈栓塞（COIL组）。COVER和COIL组的随访期分别为19 +/-2个月和10 +/-3个月。两组中的所有手术在技术上均成功，完成血管造影时无内漏证据。在随访期间，没有内漏、移植物迁移或动脉瘤扩大与覆膜或弹簧圈IIA相关。在COVER组中没有观察到临床后遗症，除了6名患者（27%）的跛行在5名患者中完全消退。在COIL组中，5例患者（45%）出现跛行。此外，COIL组发生1例股骨头坏死和1例缺血性神经病变。
结论
在每例病例中，覆盖IIA而不使用弹簧圈栓塞有效排除了CIA动脉瘤，与弹簧圈栓塞相比，并发症发生率较低。通过详细的术前成像和患者选择，多达三分之二需要IIA闭塞的患者可能不需要IIA弹簧圈栓塞。
PURPOSE
When abdominal aortic aneurysms and common iliac artery (CIA) aneurysms undergo concomitant endovascular repair, endograft limb extension into the external iliac artery is often necessary. Usually, the internal iliac artery (IIA) is coil embolized in such a case to prevent endoleak. It has been our practice to coil embolize the IIA only in cases where there is not adequate stent graft seal in the CIA immediately proximal to the IIA origin (effectively sealing the entire IIA origin). In this study, we evaluated the outcomes of this approach.
METHODS
We retrospectively reviewed 204 consecutive endovascular abdominal aortic aneurysm repairs at Dartmouth-Hitchcock Medical Center from 1996 to 2001. Computed tomographic angiography with three-dimensional reconstruction was the primary preoperative imaging modality, and the decision to cover the IIA without concomitant coil embolization was based before surgery on the presence of adequate graft oversizing (> or =10% to 15%) in the most distal 5 mm of CIA and 15 mm of proximal external iliac artery, respectively.
RESULTS
The IIA was occluded 33 times in 31 patients. In 22 cases (67%), the IIA was covered without coil embolization (COVER group). The remaining 11 patients (33%) with inadequate graft oversizing in the CIA underwent IIA coil embolization (COIL group). The follow-up periods for the COVER and COIL groups were 19 +/- 2 months and 10 +/- 3 months, respectively. All operations in both groups were technically successful without evidence of endoleak at completion angiography. No endoleaks, graft migrations, or aneurysm enlargements were associated with the covered or coiled IIAs during the follow-up period. No clinical sequelae were seen in the COVER group, with the exception of buttock claudication in six patients (27%) that resolved completely in five patients. In the COIL group, five patients (45%) had buttock claudication. In addition, one case of buttock necrosis and one case of ischemic neuropathy occurred in the COIL group.
CONCLUSION
Covering the IIA without coiling effectively excluded the CIA aneurysm in every case and was associated with a low incidence rate of complications compared with coil embolization. With detailed preoperative imaging and patient selection, IIA coil embolization may not be necessary in as many as two thirds of patients who need IIA occlusion.