How safe is bilateral internal iliac artery embolization prior to EVAR?
How safe is bilateral internal iliac artery embolization prior to EVAR?
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DOI：
10.1007/s00270-007-9203-6
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发表时间：
2008-03-01
影响因子：
2.9
通讯作者：
Morgan, R. A.
中科院分区：
文献类型：
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作者：
Bratby, M. J.;Munneke, G. M.;Morgan, R. A.
目的评估腹主动脉瘤腔内修复术（EVAR）前双侧髂内动脉（IIA）栓塞后患者的结局。方法39例患者（年龄范围55-88岁，平均72.5岁; 2例女性）在腹主动脉瘤腔内修复术前接受IIA栓塞/闭塞。其中28例为髂-双髂动脉瘤，6例为双侧髂总动脉（CIA）动脉瘤。5例单侧CIA动脉瘤患者既往手术结扎了对侧IIA或无意中被对侧IIA起源的覆膜支架覆盖。结果严重缺血性并发症仅限于脊髓缺血，1例（3%）腹主动脉瘤腔内修复术后出现下肢轻瘫。没有发生其他严重的缺血性并发症，如股骨头坏死或肠或膀胱缺血。12例患者（31%）发生臀部和/或大腿跛行，3例患者（9%）持续1年以上。性功能障碍2例（5%）。接受同时栓塞的患者的缺血性并发症发生率为25%（3/12），而接受序贯栓塞的患者为41%（11/27）（p = 0.48）。局限于IIA主干的栓塞导致16%（3/19）的缺血性并发症发生率显著降低，而在IIA远端栓塞的患者中，缺血性并发症发生率为55%（11/20）（p = 0.019，Fisher精确检验）。尽管约30%的患者在手术后不久会发生大腿/大腿跛行，但大多数患者在1年后会消退。在我们的系列中，顺序与同时IIA栓塞没有明显的受益。与远端IIA闭塞相比，近端IIA主干闭塞可减少并发症。
Purpose To assess the outcomes of patients after bilateral internal iliac artery (IIA) embolization prior to endovascular aneurysm repair (EVAR).Methods Thirty-nine patients (age range 55-88 years, mean 72.5 years; 2 women) underwent IIA embolization/occlusion before EVAR. There were 28 patients with aorto-biiliac aneurysms and 6 with bilateral common iliac artery (CIA) aneurysms. Five patients with unilateral CIA aneurysms had previous surgical ligation of the contralateral IIA or inadvertent covering by the stent-graft of the contralateral IIA origin. Outcomes were assessed by clinical follow-up.Results Severe ischemic complications were limited to spinal cord ischemia in 1 patient (3%) who developed paraparesis following EVAR. No other severe ischemic complications such as buttock necrosis, or bowel or bladder ischemia, occurred. Buttock and/or thigh claudication occurred in 12 patients (31%) and persisted beyond 1 year in 3 patients (9%). Sexual dysfunction occurred in 2 patients (5%). Patients who underwent simultaneous embolization had a 25% (3/12) ischemic complication rate versus 41% (11/27) in those with sequential embolization (p = 0.48). Embolization limited to the main trunk of the IIA resulted in a significantly reduced ischemic complication rate of 16% (3/19) versus 55% (11/20) of patients who had a more distal embolization of the IIA (p = 0.019, Fisher's exact test).Conclusion Severe complications after bilateral IIA embolization are uncommon. Although buttock/thigh claudication occurs in around 30% of patients soon after the procedure, this resolves in the majority after 1 year. There is no obvious benefit for sequential versus simultaneous IIA embolization in our series. Occlusion of the proximal IIA trunk is associated with reduced complications compared with occlusion of the distal IIA.