腹主动脉瘤腔内修复术后髂支闭塞的治疗策略及其危险因素分析  

Treatment strategies and risk factors for iliac limb occlusion after endovascular repair of abdominal aortic aneurysm

作　　者：戚悠飞[1] 王惠暄 刘飒华[1] 陈浩[1] 张文波[1] 吴鸿飞[1] 刘震东 许语阳 肖占祥[1] 李振振[1] QI Youfei;WANG Huixuan;LIU Sahua;CHEN Hao;ZHANG Wenbo;WU Hongfei;LIU Zhendong;XU Yuyang;XIAO Zhanxiang;LI Zhenzhen(Department of Vascular Surgery,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University,Haikou 570311,China;Hainan Medical University,Haikou 571199,China)

机构地区：[1]海南省人民医院/海南医学院附属海南医院血管外科,海南海口570311 [2]海南医学院,海南海口571199

出　　处：《中国普通外科杂志》2024年第6期918-925,共8页China Journal of General Surgery

基　　金：海南省科技厅重点研发(社会发展方向)基金资助项目(ZDYF2023SHFZ108);海南省自然科学基金资助项目(820MS135);海南省人民医院国家自然科学基金培育530工程基金资助项目(2021MSXM08);海南省卫生健康委员会2023年度省级临床重点学科(临床医学中心)建设单位基金资助项目[琼卫医函(2022)341号]。

摘　　要：背景与目的:腹主动脉瘤腔内修复术(EVAR)以其微创且术后恢复快的优势,已成为腹主动脉瘤(AAA)的首选治疗。髂支闭塞(ILO)是EVAR术后常见并发症,但其处理存在很多难点。因此,本文探讨EVAR术后ILO的治疗策略及其危险因素。方法:回顾性分析海南省人民医院血管外科2013年8月—2022年8月间14例EVAR术后发生ILO的病例资料。以同期435例无ILO的EVAR病例作为对照,分析EVAR术后发生ILO危险因素。结果:14例患者行腔内或杂交手术治疗的平均手术时间(183.9±32.6)min,术中出血量(187.1±70.2)mL。10例经杂交手术取栓恢复腔内血流,2例杂交手术失败后行双侧股动脉人造血管旁路术,2例采用吸栓导管行经皮机械血栓清除术恢复腔内血流。清除髂支内血栓后,对髂支及远端髂外动脉(EIA)残余狭窄性病变行球囊扩张及支架成形术。术后所有患者下肢缺血症状完全缓解。随访期,所有患者未再发下肢缺血症状。单因素分析显示,EIA起始端直径(P=0.045)、髂动脉扭曲≥60°(P=0.003)、髂动脉狭窄≥50%(P=0.007)、髂支远端锚定于EIA(P=0.015)、髂支远端放大率≥15%(P=0.028)等因素与EVAR术后ILO的发生有关。结论:腔内或杂交手术治疗是EVAR术后ILO的首选治疗。关注ILO的危险因素,并在EVAR方案设计和操作时积极预防。Background and Aims:Endovascular aneurysm repair(EVAR)has become the preferred treatment for abdominal aortic aneurysm(AAA)due to its minimally invasive nature and quick postoperative recovery.Iliac limb occlusion(ILO)is a common complication after EVAR,but its management poses many challenges.Therefore,this study was performed to explore the treatment strategies and risk factors for ILO following EVAR.Methods:The clinical data of 14 cases of ILO that occurred after EVAR admitted to Department of Vascular Surgery,Hainan General Hospital/Hainan Affiliated Hospital of Hainan Medical University between August 2013 and August 2022 were retrospectively analyzed,and 435 EVAR cases without ILO during the same period served as a control to analyze the risk factors for developing ILO after EVAR.Results:The average operative time for the 14 patients undergoing endovascular or hybrid surgery was(183.9±32.6)min,with intraoperative blood loss of(187.1±70.2)mL.Thrombus removal and restoration of intravascular blood flow were achieved through hybrid surgery in 10 cases.In two cases where hybrid surgery failed,bilateral femoral artery bypass grafting was performed.Another two cases underwent percutaneous mechanical thrombectomy using an aspiration catheter to restore intravascular blood flow.After thrombus removal from the iliac limb,balloon dilation and stent angioplasty were performed on the iliac limb and distal external iliac artery(EIA)for residual stenotic lesions.After the operation,ischemic symptoms in the lower limbs were relieved entirely in all patients.During the follow-up period,no recurrence of ischemic symptoms was observed.Univariate analysis indicated that factors such as the diameter of the proximal EIA(P=0.045),iliac artery tortuosity≥60°(P=0.003),iliac artery stenosis≥50%(P=0.007),the distal portion of the iliac limb graft anchoring to the EIA(P=0.015),and the oversize rate of the distal iliac limb graft≥15%(P=0.028)were associated with the occurrence of ILO after EVAR.Conclusion:Endovascular or hybr

关 键 词：主动脉瘤 腹 血管内操作 手术后并发症 移植物闭塞 血管 

分 类 号：R654.3[医药卫生—外科学]