一体式分叉型覆膜支架在介入治疗孤立性髂动脉瘤中的应用  

Endovascular repair of isolated iliac artery anurysm with unibody bifurcated stent-grafts

作　　者：吴文辉[1] 蒲俊舟[1] 薛玉国[1] 黄小勇[1] 郭曦[1] 李铁铮[1] 刘光锐[1] 韩晓峰[1] 黄连军[1] WU Wenhui;PU Junzhou;XUE Yuguo;HUANG Xiaoyong;GUO Xi;LI Tiezheng;LIU Guangrui;HAN Xiaofeng;HUANG Lianjun(Department of Interventional,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所介入诊疗科

出　　处：《心肺血管病杂志》2019年第5期494-498,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金(81570421)

摘　　要：目的:探讨一体式分叉型覆膜支架应用于介入治疗孤立性髂动脉瘤(IIAAs)的安全及有效性。方法:回顾性分析本中心自2011年8月至2016年7月,共7例男性患者,年龄49~82岁,平均年龄(69±10.5)岁,因IIAAs接受一体式分叉型覆膜支架介入治疗。其中单侧病变3例;双侧病变4例,4例合并髂内动脉瘤。6例患者使用Microport Aegis-B一体式分叉型覆膜支架,1例使用Powerlink一体式分叉型覆膜支架,远端共使用9枚髂动脉延长支架。1例患者行髂内动脉预栓塞以避免II型内漏。术后分别于1、6、12个月及以后每年一次行临床及影像随访。结果:7例患者均成功置入一体式覆膜支架,技术成功率为100%。一体式支架主体近端直径为24~26 mm,长度为80~90 mm。6例患者单侧髂内动脉开口覆盖,1例患者双侧髂内动脉开口覆盖,无盆腔及臀肌缺血发生,围术期无严重并发症发生。平均随访时间(32.5±19)个月(12~70个月)。患者随访期内无支架移位,无支架相关死亡等严重并发症。1例随访内发现轻度II型内漏。结论:一体式分叉型覆膜支架治疗IIAAs安全有效,近中期疗效满意,特别是对于近端锚定区不足或双侧受累的患者有其独到特殊的应用优势。Objective:To explore the safety and efficiency of endovascular treatment of isolated iliac artery aneurysm(IIAAs)with unibody bifurcated stent grafts.Methods:From August 2011 to July 2016,seven patients[male=7;average age(69±10.5)years old,ranging from 49 to 82 years old],who underwent endovascular repair because of IIAAs were enrolled.Pathologies included unilateral common iliac artery aneurysm in 3 cases,bilateral iliac artery aneurysm in 4 cases and concomitant internal iliac artery aneurysms in 4 cases.Shanghai MicroPort Aegis-B unibody stent-grafts were implanted in 6 cases and Powerlink endologix unibody stent-graft was implanted in 1 case.Nine limb extension stents were deployed to extent the distant seal zoon and ensure the complete exclusion of aneurysm disease.One case received coil embolization of right IIA prior to endograft implantation to avoid type II endoleak.Follow-up imaging consisted of contrast-enhanced CT scans at 1,6,12 months,and annually thereafter.Results:Technical success was achieved in all patients.The diameter of the main body ranged from 24-26 mm and the length ranged from 80-90 mm.Unilateral IIA orifices were covered by limb extensions in six patients and bilateral IIA orifice was covered in 1 patient.There was no obvious pelvic and gluteus ischemia complain from case 6,whose bilateral IIA were covered.No other major complications were reported.All IIAAs were excluded successfully with patent stent-grafts except small endoleak into IIA in one case.Conclusions:Endovascular treatment in IIAAs with unibody bifurcated stent-graft seems to be efficient,feasible and relatively safe treatment option,providing good short and middle term result.Such endograft has good performance especially in short or lack of proximal neck or bilateral CIAAs;Previous emboliaztion of the involved IIA beyond anurysm is strongly recommended.However,larger studies with longer follow-up are needed to establish the durability of such repair.

关 键 词：孤立性髂动脉瘤 一体式分叉型支架 介入治疗 

分 类 号：R54[医药卫生—心血管疾病]