腹主动脉瘤腔内修复术中封闭髂内动脉后的并发症及其与侧支血管形成的关系  

Complications following closure of internal iliac artery during endovascular repair of abdominal aortic aneurysm and their association with collateral formation

作　　者：刘星华 朱龙图 李涛 宋超 魏小龙 张雷 袁良喜 包俊敏 赵志青 陆清声 LIU Xinghua;ZHU Longtu;LI Tao;SONG Chao;WEI Xiaolong;ZHANG Lei;YUAN Liangxi;BAO Junmin;ZHAO Zhiqing;LU Qingsheng(Department of Vascular Surgery,Changhai Hospital,Naval Medical University,Shanghai 200433,China)

机构地区：[1]中国人民解放军海军军医大学附属长海医院血管外科,上海200433

出　　处：《中国普通外科杂志》2023年第12期1872-1881,共10页China Journal of General Surgery

基　　金：上海市科技计划基金资助项目(23XD1405000)。

摘　　要：背景与目的:腹主动脉瘤腔内修复术(EVAR)由于其安全性和有效性,已逐步成为腹主动脉瘤的一线治疗方法,虽然目前已有各种微创腔内器具和介入技术运用于髂内动脉(IIA)的保留,但临床上需封闭IIA的情况仍不少见,而一旦封闭IIA,尤其进行双侧IIA栓塞的患者,可能出现臀肌缺血、肠道缺血、性功能障碍等并发症。同时,部分IIA侧支建立良好患者行双侧IIA封闭后无明显封闭相关并发症的发生。因此,本研究探讨分析EVAR中封闭单侧或双侧IIA后,臀肌、肠道、生殖器缺血等并发症情况及其与侧支代偿之间的关系。方法:回顾性收集并分析2011年7月—2021年7月在中国人民解放军海军军医大学附属长海医院行EVAR的1902例患者的基线资料及术前、术中、术后影像学资料,筛选出426例行IIA封闭的患者(62例行双侧IIA封闭,264例行单侧IIA封闭),并进行并发症相关症状电话随访。统计患者围手术期和随访期患者臀肌缺血、肠道缺血、性功能障碍等相关并发症情况,根据术中及术后影像观察侧支代偿情况,并分析侧支建立与并发症的关系。结果:426例患者中,73例(17.1%)出现臀肌缺血症状,7例(1.6%)出现肠道缺血坏死症状,3例(0.7%)出现性功能障碍。术后1~12个月复查全主动脉CTA,321例(75.4%)存在单侧或双侧IIA侧支血管,其中143例(33.6%)有股深动脉(DFA)-IIA侧支形成,79例(18.5%)有股总动脉来源侧支,90例(21.1%)有肠系膜上动脉-IIA脏支侧支建立,7例(1.6%)存在股浅动脉-IIA侧支,7例(1.6%)存在脾动脉-IIA侧支,13例(3.1%)存在髂外动脉-IIA侧支,76例(17.8%)有来自对侧IIA的侧支。全组患者中,有侧支血管建立的患者并发症发生率明显低于无侧支建立患者(OR=4.68,95%CI=2.84~7.71,P<0.05),且主要与对侧IIA的建立有关(OR=6.30,95%CI=2.21~17.94,P<0.05)。在双侧IIA封闭的患者中,有侧支血管建立的患者并发症发生率明显低于无侧支建立患者(OR=5.Background and Aims:Endovascular aneurysm repair(EVAR)has gradually become the first-line treatment for abdominal aortic aneurysm due to its safety and effectiveness.Although various minimally invasive intravascular devices and intervention techniques are currently utilized for preserving the internal iliac arteries(IIA),cases requiring the occlusion of IIA are still not uncommon in clinical practice.Once IIA is closed,especially in patients undergoing bilateral IIA embolization,complications such as gluteal muscle ischemia,intestinal ischemia,and sexual dysfunction may arise.Additionally,some patients with well-established collateral branches of the IIA show no significant occurrence of closure-related complications after bilateral IIA closure.Therefore,the present study was performed to investigate and analyze complications such as gluteal,intestinal,and genital ischemia after the closure of unilateral or bilateral IIA in EVAR and their relationship with collateral compensation.Methods:Baseline data and preoperative,intraoperative,and postoperative imaging data of 1902 patients who underwent EVAR in Changhai Hospital from July 2011 to July 2021 were retrospectively collected and analyzed.Among them,426 patients undergoing IIA closure were selected(62 cases of bilateral IIA closure,and 264 cases of unilateral IIA closure),and complications were assessed through telephone follow-ups.Complications such as gluteal muscle ischemia,intestinal ischemia,and sexual dysfunction during the perioperative and follow-up periods were recorded.Collateral circulation was observed based on intraoperative and postoperative imaging,and the relationship between collateral establishment and complications was analyzed.Results:Of the 426 patients,73(17.1%)exhibited symptoms of gluteal muscle ischemia,7(1.6%)had symptoms of intestinal ischemic necrosis,and 3(0.7%)developed sexual dysfunction.On follow-up CTA conducted 1-12 months postoperatively,321 patients(75.4%)had unilateral or bilateral IIA collateral vessels.Among them,143 cases(

关 键 词：主动脉瘤 腹 血管内操作 髂动脉 侧支循环 并发症 

分 类 号：R543.1[医药卫生—心血管疾病]